Statement of Principles concerning Lyme disease/Lyme borreliosis (Reasonable Hypothesis) (No. 17 of 2025) (Cth)

Statement of Principles concerning LYME DISEASE/LYME BORRELIOSIS (Reasonable Hypothesis) (No. 17 of 2025) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 17 December 2024.

Professor Terence Campbell AM Chairperson by and on behalf of The Repatriation Medical Authority

Contents 1 Name 2 Commencement 3 Authority 4 Repeal 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

1. Name This is the Statement of Principles concerning Lyme disease/Lyme borreliosis (Reasonable Hypothesis) (No. 17 of 2025). 1. Commencement This instrument commences on 28 January 2025. 1. Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 1. Repeal The Statement of Principles concerning Lyme disease (Reasonable Hypothesis) (No. 25 of 2016) (Federal Register of Legislation No. F2016L00254) made under subsection 196B(2) of the VEA is repealed. 1. 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. 1. Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 1. Kind of injury, disease or death to which this Statement of Principles relates 1. This Statement of Principles is about Lyme disease/Lyme borreliosis and death from Lyme disease/Lyme borreliosis . Meaning of Lyme disease/Lyme borreliosis 1. For the purposes of this Statement of Principles, Lyme disease/Lyme borreliosis : 1. means an infection with spirochete bacteria of the Borrelia burgdorferi sensu lato complex, which has been transmitted by the bite of a tick of the genus Ixodes, in a geographic location where Lyme disease/Lyme borreliosis is endemic. 2. includes chronic untreated Lyme disease; 3. excludes Lyme-like illness; Note 1: Borrelia species which are members of the Borrelia burgdorferi sensu lato complex include Borrelia burgdorferi, B. afzelii, B. americana, B. andersonii, B. bavariensis, B. bissettii, B. californiensis, B. carolinensis, B. finlandensis, B. garinii, B. japonica, B. kurtenbachii, B. lanei, B. lusitaniae, B. mayonii, B. maritima, B sinica, B. spielmanii, B. tanukii, B. turdi, B. valaisiana, and B yangtzensis. Note 2: Ixodes species of tick known to transmit Borrelia spp. to humans include Ixodes dentatus, I. granulatus, I. jellisonii, I. minor, I. ovatus, I. pacificus, I. persulcatus, I. nipponensis, I. ricinus, I. scapularis, I. spinipalpis, I. tanukii, and I. turdus. Note 3: Geographic locations where Lyme disease/Lyme borreliosis is endemic include the United States of America, southern Canada, Europe, the United Kingdom, Russia, Japan, and north-eastern China. Note 4: Clinical manifestations of Lyme disease/Lyme borreliosis include a skin rash expanding out from the site of the tick bite (erythema migrans), headache, fatigue, joint pain and swelling, heart palpitations, irregular heartbeat, nerve pain, and facial palsy. Note 5: Lyme disease infection can be confirmed through laboratory testing of blood. The usual method is IgM and IgG serology (by enzyme-linked immunosorbent assay or immunofluorescence antibody test) followed by a Western blot if the serology was positive. Though Borrelia culture is considered the gold standard of diagnosis, it is difficult to achieve. 1. While Lyme disease/Lyme borreliosis attracts ICD‑10‑AM code A69.2, in applying this Statement of Principles the meaning of Lyme disease/Lyme borreliosis is that given in subsection (2). 2. 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. Death from Lyme disease/Lyme borreliosis 1. For the purposes of this Statement of Principles, Lyme disease/Lyme borreliosis , in relation to a person, includes death from a terminal event or condition that was contributed to by the person's Lyme disease/Lyme borreliosis . Note: terminal event is defined in the Schedule 1 – Dictionary. 1. Basis for determining the factors The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that Lyme disease/Lyme borreliosis and death from Lyme disease/Lyme borreliosis 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. 1. 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 Lyme disease/Lyme borreliosis or death from Lyme disease/Lyme borreliosis with the circumstances of a person's relevant service: 1. being exposed to spirochetes of the Borrelia burgdorferi sensu lato complex within the 33 days before clinical onset; 2. being bitten by a tick of the genus Ixodes infected with spirochetes of the Borrelia burgdorferi sensu lato complex within the 33 days before clinical onset; 3. being in a geographic location where human Lyme disease/Lyme borreliosis was endemic within the 33 days before clinical onset; 4. inability to obtain appropriate clinical management for Lyme disease/Lyme borreliosis before clinical worsening. 1. 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 factor set out in subsection 9(4) applies only to material contribution to, or aggravation of, Lyme disease/Lyme borreliosis where the person's Lyme disease/Lyme borreliosis was suffered or contracted before or during (but did not arise out of) the person's relevant service. 2. 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.