Statement of Principles concerning cervical intervertebral disc prolapse (Reasonable Hypothesis) (No. 66 of 2023) made under subsection 196B(2) of the Veterans' Entitlements Act 1986 Compilation No. 1 Compilation date: 26 March 2024 Includes amendments: Amendment Statement of Principles concerning cervical intervertebral disc prolapse (Reasonable Hypothesis) (No. 29 of 2024) (F2024L00226) The day of commencement of this Amendment Statement of Principles concerning cervical intervertebral disc prolapse is 26 March 2024. About this compilation This compilation This is a compilation of the Statement of Principles concerning cervical intervertebral disc prolapse (Reasonable Hypothesis) (No. 66 of 2023) that shows the text of the law as amended and in force on 26 March 2024. The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law. Uncommenced amendments The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the Register for the compiled law. Application, saving and transitional provisions for provisions and amendments If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes. Modifications If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the Register for the compiled law. Self‑repealing provisions If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes. Contents 1 Name 3 Authority 5 Application 6 Definitions 7 Kind of injury, disease or death to which this Statement of Principles relates 8 Basis for determining the factors 9 Factors that must exist 10 Relationship to service 11 Factors referring to an injury or disease covered by another Statement of Principles Schedule 1 - Dictionary 1 Definitions Endnotes Endnote 1—About the endnotes Endnote 2—Abbreviation key Endnote 3—Legislation history Endnote 4—Amendment history 1 Name This is the Statement of Principles concerning cervical intervertebral disc prolapse (Reasonable Hypothesis) (No. 66 of 2023). 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies. 6 Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 7 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about cervical intervertebral disc prolapse and death from cervical intervertebral disc prolapse. Meaning of cervical intervertebral disc prolapse (2) This Statement of Principles applies to cervical intervertebral disc prolapse that has been diagnosed on the basis of: (a) clinical manifestations of local pain and stiffness, or symptoms and signs of cervical spinal cord compression or cervical nerve root compression; and (b) imaging evidence of cervical intervertebral disc prolapse, including protrusion, herniation, extrusion or rupture of the nucleus pulposus or annulus fibrosis of a cervical intervertebral disc into the vertebral canal of the cervical spine. Note: imaging evidence of cervical intervertebral disc prolapse is defined in the Schedule 1 - Dictionary. It will usually be the case that the date of the imaging evidence of cervical intervertebral disc prolapse is after the date of clinical onset. (3) For the purposes of this Statement of Principles "cervical intervertebral disc prolapse" means protrusion, herniation, extrusion or rupture of the nucleus pulposus or annulus fibrosis of an intervertebral disc into the vertebral canal of the cervical spine, causing symptoms or signs, including intervertebral disc prolapses at the cervicothoracic junction. (4) The definition of cervical intervertebral disc prolapse given at subsection (3) excludes bulging of the intervertebral disc and Schmorl's nodes. (5) Whilst cervical intervertebral disc prolapse attracts ICD‑10‑AM codes M50.0, M50.1 or M50.2 in this Statement of Principles, the definition of "cervical intervertebral disc prolapse" is that given at subsection (3). (6) For subsection (5), 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. Death from cervical intervertebral disc prolapse (7) For the purposes of this Statement of Principles, cervical intervertebral disc prolapse, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's cervical intervertebral disc prolapse. Note: terminal event is defined in the Schedule 1 – Dictionary. 8 Basis for determining the factors The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that cervical intervertebral disc prolapse and death from cervical intervertebral disc prolapse 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. Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary. 9 Factors that must exist At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting cervical intervertebral disc prolapse or death from cervical intervertebral disc prolapse with the circumstances of a person's relevant service: (1) having trauma to the affected intervertebral disc within the 24 hours before the clinical onset of cervical intervertebral disc prolapse; Note: trauma to the affected intervertebral disc is defined in the Schedule 1 - Dictionary. (2) having a penetrating injury to the affected intervertebral disc or adjacent vertebral body, within the 24 hours before the clinical onset of cervical intervertebral disc prolapse; Note: penetrating injury to the affected intervertebral disc or adjacent vertebral body is defined in the Schedule 1 - Dictionary. (3) flying in high performance aircraft for a cumulative total of at least 500 hours within any 10 year period before the clinical onset of cervical intervertebral disc prolapse; Note: high performance aircraft is defined in the Schedule 1 – Dictionary. (4) flying in a helicopter as operational aircrew, for a cumulative total of at least 2,500 hours within the 10 years before the clinical onset of cervical intervertebral disc prolapse; (5) having smoked tobacco products in an amount of at least 5 pack-years before the clinical onset of cervical intervertebral disc prolapse, and if smoking has ceased before the clinical onset of cervical intervertebral disc prolapse, then that onset occurred within 5 years of cessation; Note: one pack-year is defined in the Schedule 1 - Dictionary. (6) having bacterial infection of the affected disc at the time of the clinical onset of cervical intervertebral disc prolapse; (7) having trauma to the affected intervertebral disc within the 24 hours before the clinical worsening of cervical intervertebral disc prolapse; Note: trauma to the affected intervertebral disc is defined in the Schedule 1 - Dictionary. (8) having a penetrating injury to the affected intervertebral disc or adjacent vertebral body, within the 24 hours before the clinical worsening of cervical intervertebral disc prolapse; Note: penetrating injury to the affected intervertebral disc or adjacent vertebral body is defined in the Schedule 1 - Dictionary. (9) flying in high performance aircraft for a cumulative total of at least 500 hours within any 10 year period before the clinical worsening of cervical intervertebral disc prolapse; Note: high performance aircraft is defined in the Schedule 1 – Dictionary. (10) flying in a helicopter as operational aircrew, for a cumulative total of at least 2,500 hours within the 10 years before the clinical worsening of cervical intervertebral disc prolapse; (11) having smoked tobacco products in an amount of at least 5 pack-years before the clinical worsening of cervical intervertebral disc prolapse, and if smoking has ceased before the clinical worsening of cervical intervertebral disc prolapse, then that worsening occurred within 5 years of cessation; Note: one pack-year is defined in the Schedule 1 - Dictionary. (12) having bacterial infection of the affected disc at the time of the clinical worsening of cervical intervertebral disc prolapse; (13) inability to obtain appropriate clinical management for cervical intervertebral disc prolapse before the clinical worsening of cervical intervertebral disc prolapse. 10 Relationship to service (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. (2) The factors set out in subsections 9(7) to 9(13)apply only to material contribution to, or aggravation of, cervical intervertebral disc prolapse where the person's cervical intervertebral disc prolapse was suffered or contracted before or during (but did not arise out of) the person's relevant service. 11 Factors referring to an injury or disease covered by another Statement of Principles In this Statement of Principles: (1) if a factor referred to in section 9 applies in relation to a person; and (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; then 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. Schedule 1 - Dictionary Note: See Section 6 1 Definitions In this instrument: cervical intervertebral disc prolapse—see subsection 7(2). clinical onset means the point backwards in time from the first date of imaging confirming cervical intervertebral disc prolapse, to the date at which the symptoms of cervical intervertebral disc prolapse were persistently present, as assessed by a registered medical practitioner. high performance aircraft means an aircraft capable of routinely producing an acceleration of at least 4g (4 x 9.8 m/s2). imaging evidence of cervical intervertebral disc prolapse means an image of the interior of a body obtained by medical techniques, including X-ray radiography or magnetic resonance imaging, showing cervical intervertebral disc prolapse, that is usually obtained at a date after the date of clinical onset of the disease. Note: clinical onset is defined in the Schedule 1 – Dictionary. MRCA means the Military Rehabilitation and Compensation Act 2004. one pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products. Note 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette. Note 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years. penetrating injury to the affected intervertebral disc or adjacent vertebral body means piercing of the affected intervertebral disc or adjacent vertebral body by an object such as a bullet, shell fragment, knife or needle. relevant service means: (a) operational service under the VEA; (b) peacekeeping service under the VEA; (c) hazardous service under the VEA; (d) British nuclear test defence service under the VEA; (e) warlike service under the MRCA; or (f) non-warlike service under the MRCA. Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary. terminal event means the proximate or ultimate cause of death and includes the following: (a) pneumonia; (b) respiratory failure; (c) cardiac arrest; (d) circulatory failure; or (e) cessation of brain function. trauma to the affected intervertebral disc means a discrete event involving the application of significant physical force to the affected intervertebral disc, that causes: (a) the development of symptoms and signs of pain and tenderness, and either altered mobility or range of movement of the cervical spine. In the case of sustained unconsciousness or the masking of pain by analgesic medication, these symptoms and signs must appear on return to consciousness or the withdrawal of the analgesic medication; and (b) the persistence of these symptoms and signs for a period of at least 7 days following their onset, save for where medical intervention for the trauma to the affected intervertebral disc has occurred and that medical intervention involves one of the following: (i) immobilisation of the cervical spine by splinting or similar external agent; (ii) injection of a corticosteroid or local anaesthetic into the cervical spine; or (iii) surgery to the cervical spine. VEA means the Veterans' Entitlements Act 1986. Endnotes Endnote 1—About the endnotes The endnotes provide information about this compilation and the compiled law. The following endnotes are included in every compilation: Endnote 1—About the endnotes Endnote 2—Abbreviation key Endnote 3—Legislation history Endnote 4—Amendment history Abbreviation key—Endnote 2 The abbreviation key sets out abbreviations that may be used in the endnotes. Legislation history and amendment history—Endnotes 3 and 4 Amending laws are annotated in the legislation history and amendment history. The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation. The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law. Misdescribed amendments A misdescribed amendment is an amendment that does not accurately describe how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003. If a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and "(md not incorp)" is added to the amendment history. Endnote 2—Abbreviation key ad = added or inserted orig = original am = amended par = paragraph(s)/subparagraph(s) amdt = amendment /sub‑subparagraph(s) c = clause(s) pres = present C[x] = Compilation No. x prev = previous Ch = Chapter(s) (prev…) = previously def = definition(s) Pt = Part(s) Dict = Dictionary r = regulation(s)/rule(s) disallowed = disallowed by Parliament reloc = relocated Div = Division(s) renum = renumbered exp = expires/expired or ceases/ceased to have rep = repealed effect rs = repealed and substituted F = Federal Register of Legislation s = section(s)/subsection(s) gaz = gazette Sch = Schedule(s) LA = Legislation Act 2003 Sdiv = Subdivision(s) LIA = Legislative Instruments Act 2003 SLI = Select Legislative Instrument (md not incorp) = misdescribed amendment SR = Statutory Rules cannot be given effect Sub‑Ch = Sub‑Chapter(s) mod = modified/modification SubPt = Subpart(s) No. = Number(s) underlining = whole or part not o = order(s) commenced or to be commenced Ord = Ordinance Endnote 3—Legislation history Name Registration Commencement Application, saving and transitional provisions Statement of Principles concerning cervical intervertebral disc prolapse (Reasonable Hypothesis) (No. 66 of 2023) 30 June 2023 25 July 2023 F2023L00915 Amendment Statement of Principles concerning cervical intervertebral disc prolapse (Reasonable Hypothesis) (No. 29 of 2024) 28 February 2024 26 March 2024 F2024L00226 Endnote 4—Amendment history Provision affected How affected Section 2………………. rep LA s 48D Section 4………………. rep LA s 48C Subsection 7(5)……….. rs No. 29 of 2024