{"id":"F2025L01294","name":"Statement of Principles concerning umbilical hernia, peri-umbilical hernia and para-umbilical hernia (Balance of Probabilities) (No. 92 of 2025)","slug":"f2025l01294","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":443014,"registerId":"F2025L01294-fast-fetch-1775957930566","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning umbilical hernia, peri-umbilical hernia and para-umbilical hernia (Balance of Probabilities) (No. 92 of 2025)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nUMBILICAL HERNIA, PERI-UMBILICAL HERNIA AND PARA-UMBILICAL HERNIA  (Balance of Probabilities)\n\n(No. 92 of 2025)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 24 October 2025\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\n\n \n\n   \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Repeal\n\n5 Application\n\n6 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n \n\n\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning umbilical hernia, peri-umbilical hernia and para-umbilical hernia (Balance of Probabilities) (No. 92 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 24 November 2025.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning umbilical hernia (Balance of Probabilities) (No. 94 of 2016) (Federal Register of Legislation No. F2016L01676) made under subsection 196B(3) of the VEA is repealed.\n\n1.                Application\n\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about umbilical hernia, peri-umbilical hernia and para-umbilical hernia and death from umbilical hernia, peri-umbilical hernia and para-umbilical hernia.\n\n\nMeaning of umbilical hernia, peri-umbilical hernia and para-umbilical hernia\n\n1.           For the purposes of this Statement of Principles, umbilical hernia, peri-umbilical hernia and para-umbilical hernia:\n  1.           means a protrusion of intra-abdominal tissue through a defect in the abdominal wall in the region of the umbilicus; and;\n  2.           excludes incisional hernia located at the umbilicus.\n\n\nNote: Clinical worsening can include umbilical hernia, peri-umbilical hernia or para-umbilical hernia enlargement, obstruction, incarceration, strangulation or rupture.\n\n1.           While umbilical hernia, peri-umbilical hernia and para-umbilical hernia attracts ICD‑10‑AM code K42.0, K42.1 or K42.9, in applying this Statement of Principles the meaning of umbilical hernia, peri-umbilical hernia and para-umbilical hernia is that given in subsection (2).\n2.           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.\n\n\nDeath from umbilical hernia, peri-umbilical hernia and para-umbilical hernia\n\n1.           For the purposes of this Statement of Principles, umbilical hernia, peri-umbilical hernia and para-umbilical hernia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's umbilical hernia, peri-umbilical hernia and para-umbilical hernia.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that umbilical hernia, peri-umbilical hernia or para-umbilical hernia and death from umbilical hernia, peri-umbilical hernia or para-umbilical hernia can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.\n\n1.                Factors that must exist\n\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, umbilical hernia, peri-umbilical hernia or para-umbilical hernia or death from umbilical hernia, peri-umbilical hernia or para-umbilical hernia is connected with the circumstances of a person's relevant service:\n\n1.           having a Body Mass Index (BMI) of 30 or greater at the time of clinical onset or clinical worsening;\n\n\nNote: Body Mass Index (BMI) is calculated as W/H2 where:\n\n1.      W is the person's weight in kilograms; and\n2.      H is the person's height in metres.\n  1.           having chronic (intermittent or continuous) elevation of pressure within the abdominal cavity at the time of clinical onset;\n\n\nNote: Examples of conditions or settings which can cause chronic elevation of pressure within the abdominal cavity include, but are not limited to, ascites, chronic ambulatory or automated peritoneal dialysis, extensive intra-abdominal neoplastic disease or mass, and pregnancy.\n\n1.           having acute or chronic (intermittent or continuous) elevation of pressure within the abdominal cavity at the time of clinical worsening;\n\n\nNote: Examples of conditions or settings which can cause acute or chronic elevation of pressure within the abdominal cavity include, but are not limited to, ascites, significant coughing, significant vomiting, heavy lifting, chronic ambulatory peritoneal dialysis, pregnancy and straining at stool due to constipation.\n\n1.           inability to obtain appropriate clinical management for umbilical hernia, peri-umbilical hernia or para-umbilical hernia before clinical worsening.\n\n\n1.            Relationship to service\n  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.\n  2.           The clinical worsening aspect of factors set out in section 9 apply only to material contribution to, or aggravation of, umbilical hernia, peri-umbilical hernia or para-umbilical hernia where the person's umbilical hernia, peri-umbilical hernia or para-umbilical hernia was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 9 applies in relation to a person; and\n2.           that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA;\n\n\nthen 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.\n\n \n\n \n\nSchedule 1 - Dictionary  \n\nNote:               See Section 6\n\n1               Definitions\n\nIn this instrument:\n\n                             MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n                             relevant service means:\n\n(a)          eligible war service (other than operational service) under the VEA;\n\n(b)          defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c)          peacetime service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n                             terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a)           pneumonia;\n\n(b)           respiratory failure;\n\n(c)           cardiac arrest;\n\n(d)           circulatory failure; or\n\n(e)           cessation of brain function.\n\n                             umbilical hernia, peri-umbilical hernia and para-umbilical hernia—see subsection 7(2).\n\n                             VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":true,"description":"The original 2016 instrument covered only 'umbilical hernia'. This 2025 version expands the scope to explicitly include 'peri-umbilical hernia' and 'para-umbilical hernia' in the title, definitions, and throughout the text. While medically these are closely related conditions, the legislative scope has grown from one specific diagnosis to three related diagnoses."},"complexity_factors":["Short, focused instrument (approximately 1,500 words)","Only 5 defined terms in the Dictionary (MRCA, relevant service, terminal event, VEA, and a pointer to the definition in section 7)","Clear, numbered structure with 11 main sections plus a short Schedule","Simple conditional logic: 'at least one of the following factors must exist' — no nested exceptions or complex boolean operators","Cross-references limited to: the parent Acts (VEA and MRCA), the repealed 2016 instrument, and internal references to the Dictionary","Medical terminology is explained in plain English (e.g., BMI calculation spelled out, examples given for abdominal pressure conditions)","Single purpose instrument: establishes causation factors for one specific medical condition only"],"plain_english_summary":"This instrument updates medical rules for compensating Australian veterans and current/former defence members for umbilical and related peri-/para‑umbilical hernias (excluding incisional hernias). It sets how decision-makers assess whether the condition—or its worsening—was more likely than not caused or aggravated by service.\n\nIt matters because it lists key causal factors (eg, obesity, chronic or acute intra‑abdominal pressure, lack of timely care), clarifies interaction with other condition rules, and extends compensation coverage and death‑related causation assessments."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument repeals the prior Statement of Principles concerning umbilical hernia (No. 94 of 2016) (s4) and replaces it with the current criteria (s7–s11). It continues to apply to claims under s120B VEA and s339 MRCA (s5). Key elements now set out include an explicit list of required factors (BMI ≥30, chronic or acute intra‑abdominal pressure, inability to obtain appropriate clinical management) and specific rules about clinical worsening and the requirement that factors be related to relevant service (s9–s10). Whether these changes broaden or narrow eligibility cannot be determined from this instrument alone without side‑by‑side comparison to the repealed 2016 Statement."},"complexity_factors":["Statutory basis and agency: produced by the Repatriation Medical Authority under subsection 196B(3) VEA (Authority, s3).","Cross‑legislation application: applies to claims under s120B VEA and s339 MRCA (Application, s5).","Medical definitions and coding: defines condition anatomically and references ICD‑10‑AM codes (s7(2), s7(3)).","Evidentiary standard: balance of probabilities standard stated as the basis for relating condition to service (Basis, s8).","Prescriptive causation factors: enumerates discrete medical/clinical factors that must exist (BMI, chronic/acute intra‑abdominal pressure, inability to obtain management) (Factors, s9).","Temporal/causation nuance: distinguishes clinical onset vs clinical worsening and limits when worsening can be treated as service‑related (Relationship to service, s10).","Interaction with other Statements: factors referring to other Statements of Principles apply according to those Statements (s11).","Repeal and replacement: expressly repeals the 2016 Statement, requiring comparison against prior instrument to assess substantive change (Repeal, s4)."],"plain_english_summary":"This Statement of Principles (No. 92 of 2025), issued by the Repatriation Medical Authority, sets the medical criteria used to decide whether umbilical, peri‑umbilical or para‑umbilical hernia (and death from them) can be connected to a person’s relevant service. It replaces the 2016 Statement and applies to claims under section 120B of the Veterans' Entitlements Act 1986 and section 339 of the Military Rehabilitation and Compensation Act 2004.\n\nIt lists the specific factors that must exist (for example, BMI ≥30 at clinical onset; chronic or acute intra‑abdominal pressure; inability to obtain appropriate clinical management) and requires those factors to be related to the person’s relevant service before a service connection can be found."}},"importantCases":[],"_links":{"self":"/api/acts/f2025l01294","history":"/api/acts/f2025l01294/history","analysis":"/api/acts/f2025l01294/analysis","conflicts":"/api/acts/f2025l01294/conflicts","importantCases":"/api/acts/f2025l01294/important-cases","documents":"/api/acts/f2025l01294/documents"}}