Statement of Principles

concerning

SMALLPOX
(Reasonable Hypothesis)

(No. 5 of 2026)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated   19 December 2025

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 smallpox (Reasonable Hypothesis) (No. 5 of 2026).

1.                Commencement

              This instrument commences on 19 January 2026.

1.                Authority

This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.

1.                Repeal

The Statement of Principles concerning smallpox (Reasonable Hypothesis) (No. 89 of 2016) (Federal Register of Legislation No. F2016L01669) made under subsection 196B(2) of the VEA is repealed.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 smallpox and death from smallpox.

Meaning of smallpox

1.           For the purposes of this Statement of Principles, smallpox:
   1.           means a clinical illness caused by infection with the variola virus, a member of the Orthopoxvirus genus, which has been confirmed by laboratory testing; and
   2.           includes smallpox caused by infection with variola major or variola minor strains.

Note: The most common clinical presentation of smallpox may include an acute onset of fever, prostration, headache, body aches and a vesicular or pustular rash, known as the ordinary form of smallpox caused by variola major virus.

1.           While smallpox attracts ICD‑10‑AM code B03, in applying this Statement of Principles the meaning of smallpox 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 smallpox

1.           For the purposes of this Statement of Principles, smallpox, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's smallpox.

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 smallpox and death from smallpox 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 smallpox or death from smallpox with the circumstances of a person's relevant service:

1.           being exposed to the variola virus by:
   1.           having close contact with a person who has smallpox; or
   1.           having direct contact with body fluids or tissue from a person infected with the variola virus; or
   2.           having direct contact with a laboratory strain of the variola virus; or
   3.           handling clothing, bedding, or objects contaminated with the variola virus; or
   4.           having skin penetration by an instrument contaminated with the variola virus; or
   5.            inhaling droplet nuclei or aerosols of the variola virus.   

where variola virus exposure occurs within the 4 weeks immediately preceding clinical onset;

1.           inability to access the appropriate smallpox vaccination in accordance with contemporary medical standards of the time, within the 2 years immediately preceding clinical onset;
2.           being pregnant within the 6 weeks immediately preceding clinical onset of haemorrhagic type smallpox or death from smallpox;

Note: haemorrhagic type smallpox typically involves a more severe clinical course, haemorrhage into skin lesions, multiorgan failure and is usually fatal.

1.           having a substantially compromised immune system at the time of clinical worsening due to any of the following:
   1.           chronic renal failure as indicated by:
      1.             a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or
      2.          undergoing chronic dialysis for renal failure;
   1.           haematological or solid organ malignancy;
   2.           infection with human immunodeficiency virus;
   3.           severe malnutrition (protein-calorie malnutrition associated with a Body Mass Index (BMI) of less than or equal to 18.5 kg/m2);

Note: Body Mass Index (BMI) is calculated as W/H2 where:

          (a) W is the person's weight in kilograms; and

          (b) H is the person's height in metres.

1.           solid organ, stem cell or bone marrow transplantation;
2.            taking one of the following immunosuppressive medications:
   1.             corticosteroids other than inhaled or topical corticosteroids;
   2.          drugs used to prevent transplant rejection;
   3.        tumour necrosis factor-α inhibitors;
   4.         chemotherapeutic agents used for the treatment of cancer;

1.           inability to obtain appropriate clinical management for smallpox 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 clinical worsening aspect of factors set out in section 9 apply only to material contribution to, or aggravation of, smallpox where the person's smallpox 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.

Schedule 1 - Dictionary  

Note:               See Section 6

1               Definitions

In this instrument:

                                MRCA means the Military Rehabilitation and Compensation Act 2004.

                               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 defined in the Schedule 1 - Dictionary.

                               smallpox—see subsection 7(2).

                               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.

                               VEA means the Veterans' Entitlements Act 1986.