FAQs

These Frequently Asked Questions (FAQs) are designed to provide a better understanding of the Repatriation Medical Authority (RMA) and the Statements of Principles (SOPs) produced by the RMA. They provide basic information, sometimes about fairly complex topics, and will sometimes link to more detailed information.

The Authority does not provide legal advice. This FAQ page is for informational purposes and is not a substitute for legal advice. It may not cover important issues that affect you. You should consult with your legal adviser if you have questions. Have a question that isn't answered here? Contact us.

Most Frequently Asked Questions

  1. Why are there two SOPs for each medical condition?
  2. What differences are there between the two SOPs?
  3. What claims do the Statements of Principles apply to?
  4. Are the SOPs legally binding?
  5. How do I know what is meant by a term used in a SOP? Can you give me a definition if I contact you?
  6. I have a disease that is not covered by a SOP. Can I still make a claim?
  7. Clinical onset and clinical worsening
  8. Why aren’t worsening factors easier than the causal (onset) factors?
  9. What influence do the findings of health studies of veterans have on the Authority?
  10. My treating doctor/specialist says my disease is caused by my service. S/he understands my condition best – how can the RMA ignore a specialist opinion?
  11. How does the RMA deal with injuries and diseases specific to female veterans?
  12. I have often noticed that Defence Occupational Health and Safety (OH&S) rules and exposure standards are much lower than the levels specified in SOPs (or not even included at all). If something is recognised as dangerous, how can the RMA ignore that?
  13. Do the Statements of Principles include factors for firefighting or the occupation of firefighter?
  14. Which SOP applies to my claim?
  15. When do the VEA, MRCA and DRCA apply to claims?
  16. Can I make a claim under the VEA or MRCA while the RMA is reviewing a SOP for my condition?
  17. If I have a chronic illness such as diabetes I have an increased risk from infectious diseases like influenza and Covid-19. Why isn’t my chronic illness included as a worsening factor for infectious diseases?
  18. Changes in the wording of factors
  19. Do the Statements of Principles include factors for burn pit exposure?
  20. Do the Statements of Principles include factors for agent orange exposure?

Most Frequently Asked Questions

Why are there two SOPs for each medical condition?

The legislation provides that claims for pension (and the SOPs used to determine claims) should be assessed at two different standards of proof. The more generous (beneficial) standard, known as the reasonable hypothesis standard, applies to veterans and serving members who have operational (or equivalent) service. This includes peacekeeping, hazardous and British nuclear test defence service under the Veterans’ Entitlements Act 1986 (VEA), and warlike and non-warlike service under the Military Rehabilitation and Compensation Act 2004 (MRCA). The balance of probabilities standard is for veterans and serving members with non-operational service.

Therefore, for any given condition there are two SOPs. In most cases there are at least slight differences, and in many cases the more generous reasonable hypothesis version of the SOP will contain more causal factors.

The legislation requires that the same body of evidence be interpreted differently for the two standards of proof. For the reasonable hypothesis standard, the sound medical-scientific evidence must indicate or point to a causal association between a risk factor and the disease in question. For the balance of probabilities standard the sound medical-scientific evidence must show that it is more probable than not that there is a causal association between a risk factor and the disease.

The definition of each type of service is listed in the definition section of each SOP under "relevant service". Claimants use the SOP that corresponds with the type of service they have rendered.

Some people will have both types of service. The appropriate SOP to use will depend upon exactly when the exposure or event (factor) was experienced on service.

What differences are there between the two SOPs?

When the two standards of proof are applied to the same body of sound medical-scientific evidence (SMSE) by the RMA, it is often the case that the two SOPs determined for the condition are different.  The definition of the condition (i.e. the exact nature of the injury or disease which is covered by the SOP) will always be exactly the same.

The two SOPs can differ in a number of ways:

  • a number of possible factors (or causes) may be only included in the more generous reasonable hypothesis version of the SOP;
  • if a factor is included in both versions of a SOP, the ‘dose’ or level and extent of the exposure is often different. For example, this difference could be the number of cigarettes required to be smoked, the number of hours or days an activity is required to be undertaken, the minimum period of exposure to a particular chemical or substance, or the range of chemicals or drugs which may be specified;
  • factors sometimes require the clinical onset of a condition to occur a maximum (or minimum) period of time after the exposure – this is known as latency – and can differ between the two standards of proof. For example, in a number of SoPs for cancer the latency period between exposure and onset of the cancer is 5 years in the reasonable hypothesis SoP and 10 years in the balance of probabilities SoP.

Where a factor is included in both SOPs, the factor is usually more generous in the reasonable hypothesis version of the SOP. If not more generous, the wording of the factor will be the same in both SOPs.

What claims do the Statements of Principles apply to?

The Statements of Principles (SOPs) apply if you are making a claim under the Veterans' Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA).

The SOPs do not apply if you are making a claim under the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (DRCA).

Are the SOPs legally binding?

Yes. The SOPs determined by the RMA are legislative instruments, and unless ‘disallowed’ by Parliament have the same legal effect as any legislation passed by Parliament. SOPs are binding on determining authorities at all levels (i.e. the Repatriation Commission and the Military Rehabilitation and Compensation Commission and their delegates, Veterans’ Review Board and Administrative Appeals Tribunal), including the courts.

SOPs exclusively state what factors must exist to establish a causal connection between particular diseases, injuries or death and service.

The SOPs apply to claims made under both the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). In the case of the MRCA, in some (very limited) circumstances SOPs do not apply. These include claims relating to temporary aggravation or temporary contribution to a sign or symptom of an injury or disease (section 30) and claims relating to an injury or disease arising from the unintended consequences of treatment provided by the Commonwealth (section 29).

Apart from the exceptions referred to above, all claims relating to an injury, disease or death under the VEA and the MRCA must be assessed by reference to the relevant SOP (where such a SOP exists, having regard to the definition in clause 3 which defines the condition covered). A claim must comply with (or ‘fit’) a factor contained within the relevant SOP in order for it to be accepted.

How do I know what is meant by a term used in a SOP? Can you give me a definition if I contact you?

Definitions of many terms used in a SOP are often contained in the SOP. A definition of what exactly is meant by the name of the injury or disease is contained in clause 3 of every SOP under the heading ‘Kind of injury, disease or death’. Many of the terms used in the factors listed in a SOP are also defined, in Schedule 1 of every SOP* under the heading ‘Dictionary’. The terms (or phrases) defined are listed in alphabetical order.

If there is no definition within a particular SOP, then the ordinary meaning found in a relevant technical (usually medical) dictionary may be used, or a general dictionary. In some cases, the courts have provided guidance on how to interpret the meaning of a word or expression, which is then binding on decision-makers. An example of this is the guidance given by a range of AAT and Federal Court cases discussing the interpretation of the term ‘clinical onset’ (which includes Re Robertson and Repatriation Commission (1998), Repatriation Commission v Cornelius (2002), Lees v Repatriation Commission (2002) (FCAFC) and Repatriation Commission v Gosewinckel (1999).

The interpretation of a term used in a SOP is a matter for the decision-maker, where no definition is included and where no judicial guidance is available. If you believe that a term has not been interpreted as it should be, a review of the decision (and interpretation) can be sought by an appeal body or court. It is generally not appropriate for the RMA to indicate what it meant a term to mean. However, if the RMA is of the opinion that an interpretation is being applied which is not consistent with its intention or the medical-science on which it relied, it has the power to amend a SOP.

* note that in some older SOPs determined pre-2015 definition of words or terms are set out in clause 9 of each SOP under the heading ‘Other definitions’.

I have a disease that is not covered by a SOP. Can I still make a claim?

Claims concerning diseases and injuries that are not covered by SOPs can still be lodged with and determined by the Department of Veterans’ Affairs, but are determined by having regard to available medical opinions and evidence rather than a SOP. Opinions may vary, and the decision-maker is required in such cases to reach a conclusion about the causal relationship of the condition with service on the basis of all of the available relevant evidence.

Clinical onset and clinical worsening

The Statements of Principles (SOPs) set out the factors that the Repatriation Medical Authority (RMA) recognises as potential medical causes of either the clinical onset or clinical worsening of a particular kind of injury, disease or death.

What is a clinical onset?

Clinical onset is determined by a relevant expert or medical practitioner.

Generally 'clinical onset' of a particular kind of injury or disease occurs when a relevant expert such as a medical practitioner, can conclude that a particular symptom or other feature means that a claimant veteran or member had that injury or disease at a particular time.

The RMA does not define 'clinical onset' for each particular kind of injury or disease under consideration as that determination depends on the nature of that disease or injury and the specific facts of an individual veteran’s or member's case.

In many instances the clinical onset of a disease may be difficult to determine as the date of diagnosis is not the date of clinical onset, onset preceding diagnosis. The normal practice is for a medical practitioner to make the diagnosis of the disease, and then work backwards from the date of diagnosis to estimate a date of clinical onset based on the first appearance of a symptom or feature which is indicative of the disease. The medical adviser is likely to be assisted by having access to service related records including medical records.

The clinical onset of an injury is normally straightforward since the injury event and diagnosis generally occurs over a very short period of time.

What is a clinical worsening?

The Repatriation Medical Authority (RMA) does not usually define 'clinical worsening' for each particular kind of injury or disease under consideration as this issue is based on a consideration of the particular kind of injury or disease, its natural progression and consequences, and the specific facts of an individual veteran's or member's case.

For a SOP factor for clinical worsening to apply it:

  • must be related to military service; and
  • must relate to an injury or disease which was suffered or contracted before or during (but did not arise out of) the person’s service. 

A clinical worsening of an injury or disease may be gauged by a permanent increase in the range of symptoms, symptom severity, or symptom frequency, or by an increase in the requirements for treatment.

The facts of each case need to show:

  • a worsening of the particular kind of injury or disease out of keeping with the natural progression of the underlying pathology; and
  • that the worsening is permanent.

Why aren’t worsening factors easier than the causal (onset) factors?

It is often the situation that there is very little (if any) medical-scientific study in relation to the aggravation or worsening of injuries or diseases. Where the RMA believes that there is a reasonable hypothesis (or it is more likely than not) that a factor that causes a disease will make it worse – whether on the basis of medical-scientific studies or clinical knowledge – unless there is clear evidence to support a lower ‘dose’ its practice is to use the same dose as for the causal (onset) factor. This is because the RMA tends to set the causal dose as low as possible consistent with the evidence available to it, and cannot reduce the dose any further without a clear scientific basis.

It is not necessarily the case that further exposure will cause further injury or worse disease because the human body has adaptive mechanisms that respond to exposure to chemicals or to physical stresses. For example, bones and cartilage are structured in such a way that they maintain their strength with usage.

What influence do the findings of health studies of veterans have on the Authority?

Where there are data available from studies of military personnel (or veterans), these are certainly taken into account. However, whilst the amount of medical-scientific literature available is ever increasing, there are not many military studies available and studies are often of relatively small numbers of subjects, reducing the ability to identify uncommon outcomes.

Another common limitation of military studies is that they often have little or no assessment of exposures, so it is not possible to determine the specific cause of any increased rates of disease. Where exposures have been measured, assessment is often done retrospectively (after return from deployments). Information obtained retrospectively and without objective verification can be subject to inaccuracies. Therefore, information on exposures can often only be identified from well-designed studies of civilians.

A large proportion of the epidemiology about the causation of disease is derived from such studies of civilians. Studies which are often of particular importance are prospective occupational studies, where levels of exposure can be quantified with a high level of precision. Where military studies are available, the RMA obtains and considers the findings. If those studies are large, well-designed and reliable, a great deal of weight will be attached to their findings.

It is interesting to note that the sound medical-scientific evidence (SMSE) relied upon to include some of the causal factors in SOPs which are commonly associated with military experiences –such as exposure to dioxins in Vietnam, atomic radiation or benzene - were actually based to a large extent on health studies of civilian or occupational groups. Such studies include agricultural and forestry workers (applying pesticides), residents in the vicinity of Hiroshima, Nagasaki and Chernobyl (radiation exposure) and chemical and petroleum industry workers (benzene exposure).

My treating doctor/specialist says my disease is caused by my service. S/he understands my condition best – how can the RMA ignore a specialist opinion?

Treating clinicians are usually the best placed to understand a veteran’s condition, and in most cases their opinions in relation to individual claims for pension are accepted. Decisions about the appropriate diagnosis of a condition, the likely date of clinical onset and the level of impairment, which have to be made by the Repatriation Commission or other decision-makers, usually rely upon reports and opinions of a treating doctor or specialist.

The RMA however does not deal with individual claims, but determines SOPs which set out all of the potential causes (factors) that can cause or worsen a particular injury, disease or death – at least one of which must as a minimum exist to establish a causal connection for the condition with the circumstances of an individual’s service. In making decisions about the various causes of an injury or disease, the RMA can only take in to account “sound medical-scientific evidence” (SMSE) as defined in the Veterans’ Entitlements Act 1986 (VEA). If your treating doctor or specialist is of the opinion that your disease is caused by a factor which is not included in the relevant SOP, the RMA can certainly consider the published study – or other evidence - which led to the doctor being of that opinion.

How does the RMA deal with injuries and diseases specific to female veterans?

There are a number of different ways in which the RMA has addressed diseases and injuries experienced by female serving members and veterans.

Some SOPs are specific to injuries or diseases which only (or largely) affect females. These SOPs are:

Some SOPs concern injuries or diseases where females are at increased risk. Some examples include:

Some factors contained in SOPs relate to risk factors which are specific to females, including oral contraception, hormone replacement therapy, oestrogen therapy, reproductive factors, pregnancy, childbirth and the puerperium. It has also been recognised that measures of overweight and obesity are different in males and females.

Where the evidence allows, different doses in factors may be specified for females. A distinction between doses for males and females is often difficult to quantify due to lack of studies which specifically measure exposures in females. Due to the strength and the quality of the evidence, the RMA has been able to make a lower dose for alcohol consumption in relation to a number of SOPs. However evidence concerning different quantities of load bearing in females compared to males in relation to musculoskeletal conditions is currently not sufficient in quality and quantity to enable different minimum loads to be prescribed by gender. The RMA currently uses the lowest possible load bearing dose consistent with the evidence for both males and females.

You can read in more detail about these issues in the 'Risk factors and SOPs concerning female veterans' (PDF 57KB) (Word 51KB) document.

I have often noticed that Defence Occupational Health and Safety (OH&S) rules and exposure standards are much lower than the levels specified in SOPs (or not even included at all). If something is recognised as dangerous, how can the RMA ignore that?

OH&S rules and standards are based upon what is known as the ‘precautionary principle’, and are usually set at a level regarded as sufficiently safe that no worker, even exposed day after day for a working lifetime, would suffer an adverse health effect, even of a temporary nature. They identify the highest dose that has not caused the most sensitive effect, and then build in safety factors of at least 10. The safety factor allows for such things as interspecies extrapolation, human variability in responses, variations in study durations, elimination half lives and absorption efficiency by different routes of exposure. The rules and standards are designed to protect workers from any adverse health effects and not necessarily a specific injury or disease.

When the RMA is considering what the minimum ‘dose’ level required to connect the injury or disease with a person’s military service, it identifies the published medical-scientific studies relating to the particular injury or disease and then specifies dose levels at the lowest level at which studies have shown exposed subjects developing the injury or disease. In most cases this will be at much higher levels than the OH&S standard.

Do the Statements of Principles include factors for firefighting or the occupation of firefighter?

The RMA is aware of concerns relating to firefighting. The occupation of firefighting, as well as chemicals or activities to which firefighters might be exposed, are considered when investigating relevant conditions. This has led to the development of a number of exposure factors which are either specific to, or could logically be linked to, firefighters.

For example, there is a factor concerning firefighting in the SOPs for mesothelioma. There is a factor concerning exposure to smoke from fires in the SOPs for chronic obstructive pulmonary disease and bronchiectasis. There is a factor concerning inhalation of ambient highly polluted air in the SOPs for ischaemic heart disease. If firefighters are exposed to asbestos, they are covered by the asbestos factors in a range of SOPs. If a firefighter is exposed to a severe traumatic event, including a life-threatening event or witnessing a person being killed, there is a relevant factor within a number of SOPs for mental health disorders and other conditions.

A firefighter may be exposed to many chemicals during the course of service, and the Department of Veterans' Affairs has received two reports from Douglas Consulting Australia setting out toxicological profiles for 210 chemicals listed as contaminants within the RAAF Base, Point Cook former fire training area. Those reports are to be found at:

First Report: Firefighter chemical review - ARP1701

Second Report: Firefighter chemical review - extension to review additional chemical substances - ARP 1701

In order to assist stakeholders including firefighters the RMA has prepared two tables:

The use of these tables is subject to the caveats outlined below.

Table 1  Firefighting – Correlation of chemical pathogens identified in Douglas Consulting reports with factors in the Statements of Principles

This table sets out the chemicals outlined in the Firefighter Chemical Review reports and cross-references them to the factors in the various Statements of Principles.

A direct correlation of the specific chemicals identified in the Douglas Consulting Reports and the SOPs is not possible as the sound medical-scientific evidence available to the RMA that is used in determining SOP factors may only refer to classes or groups of chemicals. Therefore, even though the chemical may not specifically be named in the SOP, it may still be covered by virtue of the fact that it belongs to a larger group of chemicals.

This means that it will be necessary for stakeholders and claimants to check all of the factors for the disease, injury or death being considered, as there may be a range of relevant chemical factors. Expert scientific advice may be necessary to correlate a particular chemical with the class or group of chemicals to which it belongs to identify the appropriate SOPs.

A good example of the complications here can be seen when considering the organic compound acetone. Acetone is specifically listed among the volatile substances in the reasonable hypothesis SOP concerning anosmia. However, acetone belongs to the class of chemicals known as oxygenated organic solvents, it is also classed as a ketone, and is a breathable chemical that produces psychoactive vapours. It is therefore covered by a number of SOPs that include those types of chemicals, although the SOPs may not specifically include mention of acetone itself.

Example concerning acetone as a risk factor

Factor relating to acetone

SOPs

inhaling fumes from a volatile substance from the specified list of volatile substances for a cumulative period of at least 5,000 hours before the clinical onset of anosmia and where that exposure has ceased, the clinical onset of anosmia has occurred within one year of cessation;

 

specified list of volatile substances means: (a) acetone;

 

Anosmia

(19/2021)

Acetone is an oxygenated organic solvent. Oxygenated organic solvents are included in organic solvent lists in these SOPs.

Anosmia (19/2021)

IgA nephropathy (63,64/2021)

Multiple sclerosis (11/2020)

Rapidly progressive crescentic glomerulonephritis (45/2019)

Systemic sclerosis (25/2018)

Acetone is a ketone. Ketones are included in the specified organic solvent list in this SOP.

Erectile dysfunction (43/2013)

 

Acetone is an inhalant (breathable chemicals that produce psychoactive vapours and include organic solvents). Inhalants are included in drug lists in these SOPs. The SOPs concerning the disorders of mental health also define organic solvents, and include oxygenated organic solvents in the list.

Bipolar disorder (53/2018)

Depressive disorder (83,84/2015)

Epileptic seizure (77,78 /2013)

Schizophrenia (83,84/2016)

 

Table 2  Firefighting - Correlation of non-chemical pathogens and exposures with factors in the Statements of Principles

In this table, the RMA having considered the activities associated with the occupation of firefighting, has reviewed the SOPs to see what diseases or injuries those activities may be implicated in.

This has been done to assist stakeholders including claimants. It is not to be seen as prescriptive or definitive.

In particular each potential claimant has to consider their individual circumstances to see what factors may be relevant to their own particular kind of disease or injury. 

 

Which SOP applies to my claim?

The definition of each type of service is listed in the Schedule 1 – Dictionary contained in each SOP under the term "relevant service". You should use the SOP which corresponds to the type of service you have rendered.

Some people will have both types of service. The appropriate SOP to use will depend upon exactly when the exposure or event (factor) was experienced during service, and what kind of service was being undertaken at the time.

Some factors require a ‘dose’ of exposure to an agent or activity (for example, lifting a certain amount of weight within a certain period; a cumulative number of flying hours, or smoking a cumulative number of cigarettes). In some cases the ‘dose’ can only be met by combining the exposure experienced in different periods and types of service.

In those circumstances, if the combination of exposure experienced during operational and non-operational service exposure meets the minimum requirement specified in the balance of probabilities SOP, the claim is likely to succeed.

If not, if the combination of operational and non-operational service exposure meets the minimum requirement specified in the reasonable hypothesis SOP, and the operational service contribution is considered to be ‘a material contribution’ (as clarified by the Federal Court decisions of Kattenberg [Kattenberg v Repatriation Commission [2002] FCA 412] and Bendy [Repatriation Commission v Richard Edward Bendy [1989] FCA 170), the claim is likely to succeed.

Further information in relation to this issue can be obtained from the Department of Veterans’ Affairs via email (GeneralEnquiries@dva.gov.au) or telephone (133 254).

When do the VEA, MRCA and DRCA apply to claims?

This depends on your answers to two questions:-

  1. When did your injury occur or your disease commence? You should get medical advice about the commencement date of a disease (See FAQ No 7: Clinical onset and clinical worsening).
  2. What type of service were you engaged in on the date when the injury occurred or the disease commenced?

With these two matters in mind the table below sets out which of the VEA, MRCA or DRCA applies to your circumstances. You need to go to the type of service first and then the date.

Type of service  when injury or disease occurred

Date of service when injury or disease occurred

What legislation applies to my claim?

Warlike, non-warlike and operational service

 

Up to and including 6 April 1994

VEA

 

7 April 1994 to 30 June 2004

VEA and DRCA

 

1 July 2004 to today

MRCA

Peacekeeping, hazardous and British nuclear test service[1]

3 January 1949 to 30 June 2004

VEA and DRCA

Peacetime service for a continuous full-time period of 3 years or longer

Up to and including 6 December 1972

DRCA (including provisions grandfathered from 1930 and 1971 compensation Acts)

 

7 December 1972 to 6 April 1994

VEA and DRCA

 

7 April 1994 to 30 June 2004

DRCA

 

1 July 2004 to today

MRCA

Peacetime service and:

-        You enlisted prior to 22 May 1986; and

-        You continually served up to and after 7 April 1994

7 April 1994 to 30 June 2004

VEA

Peacetime service – continuous full-time less than 3 years OR part-time

Up to 30 June 2004

DRCA

 

1 July 2004 to today

MRCA

Peacetime service –

-        continuous full-time less than 3 years; and

-        discharged on medical grounds

up to 7 April 1994

VEA

For confirmation of your eligibility for one of these Acts, it is recommended that you contact the Department of Veterans’ Affairs by telephone on 1800 555 254, or via the website: www.dva.gov.au.

[1] Peacekeeping, hazardous and British nuclear test service is included as non-warlike service  from 1997 onwards

Can I make a claim under the VEA or MRCA while the RMA is reviewing a SOP for my condition?

Yes, you can.

A review of an existing Statement of Principles (SOP) by the RMA does not affect your ability to make a claim under either the Veterans' Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA).

If I have a chronic illness such as diabetes I have an increased risk from infectious diseases like influenza and Covid-19. Why isn’t my chronic illness included as a worsening factor for infectious diseases?

Some chronic conditions cannot be included as worsening factors in a Statement of Principles (SOP) of a particular disease.

This is because a condition can only be included as a worsening factor if it arises as a result of service rendered after the veteran or member contracted the particular disease it worsens (see subsections 8(1)(d) and 9(1)(d) of the Veterans' Entitlements Act 1986 and subsections 27(1)(d) and 28(1)(d) of the Military Rehabilitation and Compensation Act 2004).

For example, having diabetes can increase the risk of severe disease, disability and death in a person who gets COVID-19 but would not qualify as a worsening factor for COVID-19, even if it could be linked to military service because the diabetes will not arise as a result of military service after the onset of COVID-19.

However, where you have a pre-existing chronic condition such as diabetes, an infectious disease such as COVID-19 may increase the risk of disability and death from the diabetes.  Therefore the infectious disease may materially contribute to or aggravate that chronic condition. Should this condition otherwise qualify for compensation, the assessment of material contribution or aggravation is made on a case-by-case basis by the Repatriation Commission or the Military Rehabilitation and Compensation Commission.

Changes in the wording of factors

Sometimes after a review the wording of factors changes but the meaning stays the same.

For example the dose, duration and latency period associated with a particular cause stays the same but the presentation changes.

Why are these changes being made?

In order to assist the users, particularly the veterans and serving members, the Authority is reviewing the factors for each disease or injury with the goal of expressing them in a clearer style.

No veteran or serving member will be disadvantaged by any change in style. Legally, where a later instrument expresses the same ideas in a different form of words, the ideas are not interpreted differently merely because different forms of words have been used (section 15AC of the Acts Interpretation Act 1901).

If any user has any queries or concerns about a factor they can contact the Registrar for assistance - see http://www.rma.gov.au/contact-us/.

Do the Statements of Principles include factors for burn pit exposure?

The Repatriation Medical Authority has been keeping a close eye on the potential adverse health effects of burn pits.

The focus of the RMA is on particular kinds of disease, injury or death, rather than on the diseases or injuries, that one particular type of exposure such as burn pits may potentially cause. However, during each pending RMA investigation into a particular kind of disease, injury or death, the sound medical scientific literature is specifically searched for evidence of burn pit exposure as a potential risk factor for that disease.

Many SoPs contain factors for specific chemical inhalation that may have part of the incinerated material in the burn pit, and there are some SoPs that contain factors for smoke inhalation (methaemoglobinaemia, sinusitis, bronchiectasis, chronic obstructive pulmonary disease, fibrosing interstitial lung disease, malignant neoplasm of the nasopharynx, malignant neoplasm of the larynx, and malignant neoplasm of the lung). It is suggested that a user of the SoP system begin with the disease or injury contended to be linked with military service, and examine the RMA website for the SoPs relating to that disease or injury. Then the SoP user could examine the SoP contents for any smoke factors or chemical exposure factors. If there is a relevant specific chemical exposure factor, then the issue would be whether the veteran was likely exposed to that chemical when it was incinerated in the burn pit.

In addition, note the RMA website under frequently asked questions on firefighting, has provided a list of potential chemical factors in RMA disease SoPs. 

 Poisson et al (2020)[1]  in a review stated a burn pit was an open hole dug in the ground to burn garbage and military wastes. The wastes were incinerated with the use of various accelerants including jet fuel JP-8, with the fire burning 24 hours/day for weeks to months. The wastes were diverse and varied, but the authors noted “…plastics, tires, paints, batteries, Styrofoam, medical waste, electronic equipment, pesticides, and human trash…”. Coughlin et al (2019)[2] also mentioned “harmful particulates, and chemicals including dioxins, furans, lead, mercury, volatile organic compounds, and polycyclic aromatic hydrocarbons”.

 [1] Poisson C, Boucher S, Selby D, et al (2020). A Pilot Study of airborne hazards and other toxic exposures in Iraq War veterans. Int J Environ Res Public Health, 17(9): 3299.

[2] Coughlin SS, Szema A (2019). Burn pits exposure and chronic respiratory illnesses among Iraq and Afghanistan veterans. J Environ Health Sci, 5(1): 13-4.

Examples of some potential burn pit exposure factors

Do the Statements of Principles include factors for agent orange exposure?

Agent Orange was a mixture of chemicals used as a defoliant in the Vietnam War. Agent orange contained a 50:50 mixture of the phenoxy acid herbicides 2,4-dichlorophenoxyacetic acid (2,4-D), and 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), as well the contaminant dioxin that was introduced during manufacture of the herbicides.

The Repatriation Medical Authority (RMA) during the conduct of disease investigations, has and will consider the constituent chemicals of agent orange as potential risk factors for disease. The RMA website factor search can be utilised to search for herbicide or dioxin.

If the RMA considers a causal link between a particular kind of disease and phenoxy acid herbicide or dioxin, then there will be a factor for phenoxy acid herbicides or dioxin.

 Phenoxy acid herbicide factor

inhaling, ingesting or having cutaneous contact with the phenoxy acid herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) or 2,4,5-trichlorophenoxyacetic acid (2,4,5-T):

(a) for a cumulative period of at least 1,000 hours within a consecutive period of 10 years, before the clinical onset/worsening of sopname; and
(b)  where the first exposure occurred at least 5 years before the clinical onset/worsening of sopname; and

if that exposure has ceased before the clinical onset/worsening of sopname, then that onset/worsening occurred within 25 years of cessation;

 Dioxin factor

inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD):

(a) for a cumulative period of at least 1,000 hours within a consecutive period of 10 years, before the clinical onset/worsening of sopname; and
(b) where the first exposure occurred at least 5 years before the clinical onset/worsening of sopname; and

if that exposure has ceased before the clinical onset/worsening of sopname, then that onset/worsening occurred within 25 years of cessation;

Note: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 – Dictionary.

inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) means:

(a) decanting or spraying;
(b) cleaning or maintaining equipment used to apply;
(c) being sprayed with;
(d) handling or sawing timber treated with;
(e) being in an environment shrouded in dust from timber treated with; or
(f) using cutting oils contaminated with;

one of the following chemicals:

      (i) 2,4,5-trichlorophenoxyacetic acid;
      (ii) 2,4,5-trichlorophenoxypropionic acid;
      (iii) 2,4,5-trichlorophenol;
      (iv) 2-(2,4,5-trichlorophenoxy)-ethyl 2,2-dichloropropionate;
      (v) o,o-dimethyl-o-(2,4,5-trichlorophenyl)-phosphorothioate;
      (vi) pentachlorophenol;
      (vii) 2,3,4,6-tetrachlorophenol;
      (viii) 2,4,6-trichlorophenol;
      (ix) 1,3,5-trichloro-2-(4-nitrophenoxy)benzene;
      (x) 2,4-dichloro-1-(4-nitrophenoxy)benzene; or
      (xi) 2,4-dichloro-1-(3-methoxy-4-nitrophenoxy)-benzene.

 Vietnam factor which is a surrogate for exposure to agent orange

being:

(i) on land in Vietnam;
(ii) at sea in Vietnamese waters; or
(iii) on board a vessel and consuming potable water supplied on that vessel, when the water supply had been produced by evaporative distillation of estuarine Vietnamese waters;

for a cumulative period of at least 30 days, at least five years before the clinical onset of sopname;

Note: being: (a) on land in Vietnam; or (b) at sea in Vietnamese waters; and estuarine Vietnamese waters and potable water are defined in the Schedule 1 – Dictionary.

being:

(i)          on land in Vietnam; or

(ii)        at sea in Vietnamese waters;

 means service in at least one of the areas and at the times described in Items 4 and 8 of Schedule 2 of the VEA;