Statement of Principles concerning adrenal insufficiency (Balance of Probabilities) (No. 72 of 2018)

Administered by Department of Veterans' Affairs

Legislation au F2018L01183 In force Legislative Instrument

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EXPLANATORY STATEMENT

 

STATEMENT OF PRINCIPLES CONCERNING

ADRENAL INSUFFICIENCY

(BALANCE OF PROBABILITIES) (NO. 72 OF 2018)

 

VETERANS' ENTITLEMENTS ACT 1986

MILITARY REHABILITATION AND COMPENSATION ACT 2004

 

  1. This is the Explanatory Statement to the Statement of Principles concerning adrenal insufficiency (Balance of Probabilities) (No. 72 of 2018).

Background

2.             The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA), repeals Instrument No. 75 of 2009 (Federal Register of Legislation No. F2009L04046) determined under subsection 196B(3) of the VEA concerning adrenal insufficiency.

3.             The Authority is of the view that on the sound medical-scientific evidence available it is more probable than not that adrenal insufficiency and death from adrenal insufficiency can be related to particular kinds of service.  The Authority has therefore determined pursuant to subsection 196B(3) of the VEA a Statement of Principles concerning adrenal insufficiency (Balance of Probabilities) (No. 72 of 2018).  This Instrument will in effect replace the repealed Statement of Principles.

Purpose and Operation

4.             The Statement of Principles will be applied in determining claims under the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA).

5.             The Statement of Principles sets out the factors that must exist, and which of those factors must be related to the following kinds of service rendered by a person:

 eligible war service (other than operational service) under the VEA;

 defence service (other than hazardous service and British nuclear test defence service) under the VEA;

 peacetime service under the MRCA,

before it can be said that, on the balance of probabilities, adrenal insufficiency or death from adrenal insufficiency is connected with the circumstances of that service.  The Statement of Principles has been determined for the purposes of both the VEA and the MRCA.

6.             This Instrument results from an investigation notified by the Authority in the Government Notices Gazette of 19 October 2016 concerning adrenal insufficiency in accordance with section 196G of the VEA.  The investigation involved an examination of the sound medical-scientific evidence now available to the Authority, including the sound medical-scientific evidence it has previously considered.

7.             The contents of this Instrument are in similar terms as the repealed Instrument.  Comparing this Instrument and the repealed Instrument, the differences include:

  • adopting the latest revised Instrument format, which commenced in 2015;
  • specifying a day of commencement for the Instrument in section 2;
  • revising the definition of 'adrenal insufficiency' in subsection 7(2);
  • revising the reference to 'ICD-10-AM code' in subsection 7(4);
  • revising the factors in subsections 9(2) & 9(14) concerning 'infiltration of the adrenal glands';
  • revising the factors in subsections 9(3) & 9(15) concerning 'infection with human immunodeficiency virus';
  • revising the factors in subsections 9(4) & 9(16) concerning 'an injury or surgery';
  • revising the factors in subsections 9(5) & 9(17) concerning 'haemorrhage or infarction';
  • revising the factors in subsections 9(6) & 9(18) concerning 'an infection of the adrenal glands';
  • revising the factors in subsections 9(7) & 9(19) concerning 'being treated with a drug or a drug from a class of drugs';
  • revising the factors in subsections 9(8) & 9(20) concerning 'glucocorticoid therapy';
  • revising the factors in subsections 9(9) & 9(21) concerning 'being treated with medroxyprogesterone acetate or megestrol acetate';
  • revising the factors in subsections 9(11) & 9(23) concerning 'a critical illness or injury';
  • new factors in subsections 9(12) & 9(24) concerning 'an acute, severe stressor', for adrenal crisis only;
  • new definitions of 'acute, severe stressor', 'adrenal crisis', 'category 1A stressor', 'critical illness or injury', 'extreme heat', 'glucocorticoid therapy as specified', 'MET', 'MRCA', 'Specified List 1 of drugs', 'Specified List 2 of drugs', 'specified list of infectious organisms', 'specified list of infiltrative disorders' and 'VEA' in Schedule 1 - Dictionary;
  • revising the definitions of 'equivalent glucocorticoid therapy', 'equivalent inhaled glucocorticoid', 'high or very high potency topical glucocorticoid' and 'relevant service' in Schedule 1 - Dictionary; and
  • deleting the definitions of 'a drug from specified list 1', 'a drug from specified list 2', 'a specified disorder', 'an organism from the specified list' and 'having glucocorticoid therapy as specified'.

Consultation

8.             Prior to determining this Instrument, the Authority advertised its intention to undertake an investigation in relation to adrenal insufficiency in the Government Notices Gazette of 19 October 2016, and circulated a copy of the notice of intention to investigate to a wide range of organisations representing veterans, service personnel and their dependants.  The Authority invited submissions from the Repatriation Commission, organisations and persons referred to in section 196E of the VEA, and any person having expertise in the field.  No submissions were received for consideration by the Authority during the investigation.

Human Rights

9.             This instrument is compatible with the Human Rights and Freedoms recognised or declared in the International Instruments listed in Section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.  A Statement of Compatibility with Human Rights follows.

Finalisation of Investigation

10.         The determining of this Instrument finalises the investigation in relation to adrenal insufficiency as advertised in the Government Notices Gazette of 19 October 2016.

References

11.         A list of references relating to the above condition is available to any person or organisation referred to in subsection 196E(1)(a) to (c) of the VEA.  Any such request must be made in writing to the Repatriation Medical Authority at the following address:

The Registrar

Repatriation Medical Authority

GPO Box 1014

BRISBANE    QLD    4001

Statement of Compatibility with Human Rights

(Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011)

 

Instrument No.:   Statement of Principles No. 72 of 2018

Kind of Injury, Disease or Death: Adrenal insufficiency

 

This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.

Overview of the Legislative Instrument

1. This Legislative Instrument is determined pursuant to subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA) for the purposes of the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA).  Part XIA of the VEA requires the determination of these instruments outlining the factors linking particular kinds of injury, disease or death with service such being determined solely on the available sound medical-scientific evidence.

2. This Legislative Instrument:-

  • facilitates claimants in making, and the Repatriation Commission in assessing, claims under the VEA and the MRCA respectively, by specifying the circumstances in which medical treatment and compensation can be extended to eligible persons who have adrenal insufficiency;
  • facilitates the review of such decisions by the Veterans' Review Board and the Administrative Appeals Tribunal;
  • outlines the factors which the current sound medical-scientific evidence indicates must exist before it can be said that, on the balance of probabilities, adrenal insufficiency is connected with the circumstances of eligible service rendered by a person, as set out in clause 5 of the Explanatory Statement;
  • replaces Instrument No. 75 of 2009; and
  • reflects developments in the available sound medical-scientific evidence concerning adrenal insufficiency which have occurred since that earlier instrument was determined. 

3. The Instrument is assessed as being a technical instrument which improves the medico-scientific quality of outcomes under the VEA and the MRCA. 

Human Rights Implications

4. This Legislative Instrument does not derogate from any human rights. It promotes the human rights of veterans, current and former Defence Force members as well as other persons such as their dependents, including:

  • the right to social security (Art 9, International Covenant on Economic, Social and Cultural Rights; Art 26, Convention on the Rights of the Child and Art 28, Convention on the Rights of Persons with Disabilities) by helping to ensure that the qualifying conditions for the benefit are 'reasonable, proportionate and transparent'[1];
  • the right to an adequate standard of living (Art 11, ICSECR; Art 27, CRC and Art 28, CRPD) by facilitating the assessment and determination of social security benefits;
  • the right to the enjoyment of the highest attainable standard of physical and mental health (Art 12, ICSECR and Art 25, CRPD), by facilitating the assessment and determination of compensation and benefits in relation to the treatment and rehabilitation of veterans and Defence Force members;
  • the rights of persons with disabilities by facilitating the determination of claims relating to treatment and rehabilitation (Art 26, CRPD); and
  • ensuring that those rights "will be exercised without discrimination of any kind as to race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status" (Art 2, ICESCR).

Conclusion

This Legislative Instrument is compatible with human rights as it does not derogate from and promotes a number of human rights.

 

Repatriation Medical Authority

 

 

 

 

 

 

[1] In General Comment No. 19 (The right to social security), the Committee on Economic, Social and Cultural Rights said (at paragraph 24) this to be one of the elements of ensuring accessibility to social security.

Overview

The Statement of Principles concerning adrenal insufficiency (Balance of Probabilities) (No. 72 of 2018) was enacted to address the problem of ensuring that veterans and Defence Force members who have developed adrenal insufficiency as a result of their service are eligible for appropriate compensation and treatment. This legislative instrument was introduced under the authority of the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004 by the Repatriation Medical Authority, which determined the Statement of Principles based on the latest available sound medical-scientific evidence. The purpose of the Statement of Principles is to facilitate the assessment of claims for benefits and compensation related to adrenal insufficiency, ensuring that claimants and the Repatriation Commission can rely on clear and evidence-based criteria. This instrument serves to replace the previous Statement of Principles concerning adrenal insufficiency, reflecting the advancements in medical understanding since its inception. The policy objective of this legislative instrument is to uphold the human rights of veterans and Defence Force members by ensuring their access to social security, adequate living standards, and the highest attainable standard of physical and mental health. The instrument is compatible with human rights as it does not infringe upon any rights and actively promotes the rights of affected individuals, ensuring that benefits and compensation are accessible without discrimination. This approach aligns with international human rights standards and provides a fair and transparent framework for the assessment and distribution of benefits to those who have served in the Defence Force and are suffering from adrenal insufficiency.

Scope and Application

The Statement of Principles concerning adrenal insufficiency (Balance of Probabilities) (No. 72 of 2018) applies to veterans, current and former members of the Australian Defence Force, and their dependents who are making claims under the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). It outlines the circumstances in which adrenal insufficiency, or death from adrenal insufficiency, may be considered connected to service rendered by a person. This determination is made on the balance of probabilities based on the available sound medical-scientific evidence. The Statement of Principles sets out the specific factors that must exist and be related to eligible war service, defence service, or peacetime service before a connection to adrenal insufficiency can be established. This instrument replaces the previous Statement of Principles No. 75 of 2019, reflecting updated medical-scientific evidence. The determination is made pursuant to subsection 196B(3) of the VEA and is applicable nationally, ensuring consistency in the assessment of claims across Australia. There are no stated exclusions or exemptions within this instrument, and it does not specify any particular thresholds for eligibility. The Authority has the ability to extend or restrict the application of this instrument through subordinate instruments, although no such extensions or restrictions are indicated in this determination.

Key Provisions

The Statement of Principles concerning adrenal insufficiency (Balance of Probabilities) (No. 72 of 2018) primarily serves to establish the criteria under which adrenal insufficiency or death from adrenal insufficiency can be considered connected to specific types of military service (sections 5 and 9). It outlines the factors that must exist for a service member to claim that their condition is related to their service. These factors include various medical conditions and treatments, such as infiltration of the adrenal glands, infection with human immunodeficiency virus, injury or surgery, and treatment with specific drugs, among others (subsections 9(2) to 9(24)). This Instrument replaces the previous Statement of Principles No. 75 of 2009, updating the definitions and factors based on the latest medical-scientific evidence. The obligations imposed by the Act on parties include the Repatriation Medical Authority's duty to determine the Statement of Principles based on the available sound medical-scientific evidence (subsection 196B(3)). The Repatriation Commission and the Veterans' Review Board must apply these principles when assessing and reviewing claims related to adrenal insufficiency under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. Claimants must provide evidence that their adrenal insufficiency is connected to their service, adhering to the specified factors outlined in the Act. Breach of the provisions outlined in the Statement of Principles can lead to civil and administrative consequences. While the Act does not explicitly detail criminal penalties, non-compliance with the requirements for evidence and claims processing could result in the denial of benefits or compensation. Additionally, any misrepresentation of facts or submission of false information could be subject to the general laws governing fraud and deceit, which may include fines and imprisonment. The precise penalties would depend on the jurisdiction and the specific nature of the breach.

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.