{"id":"F2025L00159","name":"Statement of Principles concerning visual refractive error (Balance of Probabilities) (No. 36 of 2025)","slug":"statement-of-principles-concerning-visual-refractive-error-balance-of-probabilities-no-36-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442744,"registerId":"F2025L00159-fast-fetch-1775957690368","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning visual refractive error (Balance of Probabilities) (No. 36 of 2025)","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\nVISUAL REFRACTIVE ERROR  (Balance of Probabilities)\n\n(No. 36 of 2025)\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 February 2025.\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 visual refractive error (Balance of Probabilities) (No. 36 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 25 March 2025.\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 myopia, hypermetropia and astigmatism (Balance of Probabilities No. 10 of 2016 (Federal Register of Legislation No. F2016L00246) made under subsection 196B(3) of the VEA is 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 visual refractive error and death from visual refractive error.\n\n\nMeaning of visual refractive error\n\n1.           For the purposes of this Statement of Principles, visual refractive error:\n  1.           means a group of eye diseases where the refractive power of the optical system in a relaxed state does not match the length of the eyeball; and\n  2.           includes:\n    1.             myopia (nearsightedness);\n    2.          hyperopia (hypermetropia, farsightedness);\n    3.        astigmatism; and\n    4.         anisometropia; and\n  3.           excludes presbyopia (age-related farsightedness).\n\n\nNote 1: The eye’s optical system is a compound lens primarily consisting of the cornea and the internal lens.\n\nNote 2: Visual refractive errors produce symptoms of blurred vision and signs of decreased visual acuity through distortion of focus as the light rays pass through the eyeball to the retina\n\nNote 3: There is also potential for the difference in refractive errors between the eyes to be substantially different (≥1 diopter). This is called anisometropia and can lead to suppression of visual acuity of one of the eyes.\n\nMyopia:\n\n1.           means a visual refractive error where the refractive power of the optical system in the relaxed state is too strong for the eyeball length (the focal length of the optical system is too short), with the focus point appearing in front rather than on the retina; and\n\n\n1.           includes:\n  1.             nearsightedness;\n  2.          benign myopia, simple myopia, school myopia, physiological myopia;\n  3.        pathological myopia, non-pathological myopia;\n  4.         curvature myopia, index myopia, refractive myopia, axial myopia;\n  5.           progressive myopia, stationary myopia;\n  6.         degenerative myopia; and\n  7.      low myopia, high myopia.\n\n\nNote: High degrees of myopia can be associated with structural change to the retina, and past terminology of pathological myopia and degenerative myopia have indicated the presence of such complications of high myopia.\n\nHyperopia:\n\n1.           means a visual refractive error where the refractive power of the optical system in the relaxed state is too weak for the eyeball length (the focal length of the optical system is too long), with the focus point appearing behind rather than on the retina; and\n\n\n1.           includes:\n  1.             farsightedness;\n  2.          hypermetropia;\n  3.        curvature hyperopia, index hyperopia, axial hyperopia; and\n  4.         low hyperopia, high hyperopia; and\n2.           excludes presbyopia (age-related farsightedness).\n\n\nAstigmatism:\n\n1.           means a visual refractive error where the refractive power of the optical system in the relaxed state is mismatched to the eyeball length as one moves around the axis of the eye, with light unable to converge to a single focus point on the retina; and\n\n\n1.           includes:\n  1.             myopic astigmatism, hyperopic astigmatism, mixed astigmatism;\n  2.          simple astigmatism, compound astigmatism;\n  3.        regular astigmatism, irregular astigmatism;\n  4.         with-the-rule astigmatism, against-the-rule astigmatism, oblique astigmatism, bioblique astigmatism; and\n  5.           corneal astigmatism, lenticular astigmatism, retinal astigmatism.\n\n\n1.           While Myopia attracts ICD-10-AM code H44.2 or H52.1, Hypermetropia attracts ICD-10-AM code 52.0, and Astigmatism attracts ICD-10-AM code H52.2, in applying this Statement of Principles the meaning of Myopia, Hypermetropia and Astigmatism 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 visual refractive error\n\n1.           For the purposes of this Statement of Principles, visual refractive error, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's visual refractive error.\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 visual refractive error and death from visual refractive error 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, visual refractive error or death from visual refractive error is connected with the circumstances of a person's relevant service:\n\n1.           having an acquired eyelid mass of the affected eye at the time of clinical onset or clinical worsening of hyperopia or astigmatism;\n2.           having a pterygium of the affected eye at the time of clinical onset or clinical worsening of astigmatism or hyperopia;\n3.           having corneal surgery of the affected eye, within the 2 years before clinical onset or clinical worsening;\n4.           having penetrating keratoplasty (corneal transplantation) of the affected eye, within the 2 years before clinical onset or clinical worsening;\n5.           having corneal scarring of the affected eye at the time of clinical onset or clinical worsening;\n6.           having keratoconus of the affected eye at the time of clinical onset or clinical worsening of myopia or astigmatism;\n\n\nNote: keratoconus is defined in the Schedule 1 – Dictionary.\n\n1.           having scleral buckle surgery of the affected eye, within the 6 months before clinical onset or clinical worsening of myopia or astigmatism;\n2.           having a natural or artificial intraocular lens that is tilted or positioned off-centre within the affected eye at the time of clinical onset or clinical worsening;\n3.           having acquired aphakia (absence of an intraocular lens) at the time of clinical onset or clinical worsening of hyperopia;\n4.       having acquired displacement of the intraocular lens at the time of clinical onset or clinical worsening;\n\n\nNote: Displacement of the lens is also known as ectopia lentis.\n\n1.       having an acquired nuclear cataract of the affected eye at the time of clinical onset or clinical worsening of myopia;\n2.       having cataract surgery of the affected eye, within the 6 months before clinical onset or clinical worsening;\n3.       having surgery for retinal detachment of the affected eye, within the 6 months before clinical onset or clinical worsening of myopia or astigmatism;\n\n\n1.       having blunt or penetrating trauma to the affected eye during the 1 month before clinical onset or clinical worsening;\n\n\nNote 1: Examples of blunt trauma include a direct blow to the eye by a fist, ball, or stone; or accidental injuries as a result of motor vehicle, sporting, or work-related accidents.\n\nNote 2: Examples of penetrating trauma include injuries by sharp and pointed objects such as needles, knives, nails, arrows, screwdrivers, pens, bullets, or glass.\n\n1.       taking any of the following medications (which cannot be ceased or substituted in the long term) within the 2 weeks before clinical onset or clinical worsening of myopia;\n  1.           acetazolamide;\n  2.           chlortalidone/chlorthalidone;\n  3.           daratumumab;\n  4.           indapamide;\n  5.           methazolamide;\n  6.            metronidazole;\n  7.           pilocarpine;\n  8.           topiramate;\n  9.             zonisamide.\n\n\n1.       inability to obtain appropriate clinical management for visual refractive error before clinical worsening.\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, visual refractive error where the person's visual refractive error 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                             keratoconus means a condition characterised by noninflammatory, usually bilateral, protrusion of the cornea.\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                             VEA means the Veterans' Entitlements Act 1986.\n\n                               visual refractive error—see subsection 7(2).\n\n \n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":true,"description":"The original 2016 instrument covered only myopia, hypermetropia and astigmatism. This 2025 version expands scope by: (1) introducing the umbrella term 'visual refractive error' as the primary condition; (2) adding anisometropia as a newly included condition; (3) significantly expanding the list of causal factors from the previous version; and (4) adding specific medication-induced causes and surgical complications that were not previously covered. The instrument has evolved from a simple condition-specific determination to a more comprehensive framework covering acquired vision problems with multiple service-related etiologies."},"complexity_factors":["Multiple nested definitions: 'visual refractive error' defined first, then myopia, hyperopia, and astigmatism each defined separately with extensive sub-lists of included conditions","Cross-referencing between instruments: requires reference to the Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004 for service definitions","Temporal conditions: 16 different factors with varying time windows (2 weeks, 1 month, 6 months, 2 years) that must be precisely calculated","Conditional logic in section 10: distinguishes between conditions arising during service versus pre-existing conditions that worsened during service","External reference to ICD-10-AM coding system (10th Edition, 2017) for disease classification","Circular definition risk: 'visual refractive error' refers to Schedule 1 for definition, but Schedule 1 refers back to section 7(2)","Medication list specificity: 9 named drugs with qualifier that they 'cannot be ceased or substituted in the long term'"],"plain_english_summary":"The RMA has issued an updated Statement of Principles replacing 2016 rules, grouping myopia, hyperopia and astigmatism as “visual refractive error” and adding anisometropia. It governs how veterans and current/former defence members claim vision problems as service-related under the VEA and MRCA by requiring a “more likely than not” connection based on listed medical factors. This determines eligibility for pensions and health care."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2016 Statement (s4) and broadens and clarifies scope: it groups refractive errors under a single \"visual refractive error\" heading (adding anisometropia) and expressly includes death from such errors (s7(2)–(4)). It also introduces a detailed list of causal factors, precise temporal windows for surgeries/trauma/medications, and cross‑references to other Statements of Principles (s9; s11). Presbyopia remains excluded (s7(2),(3))."},"complexity_factors":["Technical medical definitions and multiple subtypes (myopia, hyperopia, astigmatism, anisometropia) with exclusions (presbyopia) (s7(2)–(3)).","Temporal qualifications for causal events and interventions (e.g. 2 years, 6 months, 1 month, 2 weeks) create precise evidentiary windows (s9(3)–(11)).","List of specific medications that can trigger worsening and the requirement they \"cannot be ceased or substituted in the long term\" (s9(11)).","Requirement that at least one listed factor existed at clinical onset or clinical worsening and that the factor be related to relevant service (burden of proof on timing and relation) (s9; s10(1)).","Different treatment of clinical worsening where condition pre‑existed service (material contribution/aggravation only) (s10(2)).","Interaction with other Statements of Principles where a listed factor refers to another injury/disease (s11) — introduces cross‑instrument application and potential layering of tests.","Explicit inclusion of death from visual refractive error and definition of terminal events, expanding causal scope beyond morbidity (s7(4); Schedule 1).","Repeal of the 2016 Statement and replacement with this instrument — requires administrators and applicants to shift to the new criteria (s4).","References to ICD‑10‑AM codes for classification while adopting its own definitional text — dual reference may affect medical reporting (s7(5)–(6)).","Administrative/evidentiary burden: the statement sets medical criteria RMA uses, so decisionmakers applying this statement must interpret clinical records to match listed factors (s8–s10)."],"plain_english_summary":"This instrument replaces the 2016 Statement and sets the Repatriation Medical Authority’s medical criteria for linking visual refractive errors (myopia, hyperopia, astigmatism, anisometropia) — and death from those conditions — to a person’s relevant service for claims under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act. It lists the clinical findings, surgeries, injuries, medications and time windows the RMA requires to establish service connection on the balance of probabilities (see sections 8–10)."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-visual-refractive-error-balance-of-probabilities-no-36-of-2025","history":"/api/acts/statement-of-principles-concerning-visual-refractive-error-balance-of-probabilities-no-36-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-visual-refractive-error-balance-of-probabilities-no-36-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-visual-refractive-error-balance-of-probabilities-no-36-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-visual-refractive-error-balance-of-probabilities-no-36-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-visual-refractive-error-balance-of-probabilities-no-36-of-2025/documents"}}