{"id":"F2019L01090","name":"Statement of Principles concerning anal fissure (Balance of Probabilities) (No. 88 of 2019)","slug":"statement-of-principles-concerning-anal-fissure-balance-of-probabilities-no-88-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440200,"registerId":"F2019L01090-fast-fetch-1775955919715","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning anal fissure (Balance of Probabilities) (No. 88 of 2019)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nANAL FISSURE (Balance of Probabilities)\n\n(No. 88 of 2019)\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 23 August 2019\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
|\n| --- |\n| 
Professor Nicholas Saunders AO
Chairperson
|\n\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\n1 Name\n\nThis is the Statement of Principles concerning anal fissure (Balance of Probabilities) (No. 88 of 2019).\n\n2 Commencement\n\n This instrument commences on 23 September 2019.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning anal fissure No. 74 of 2010 (Federal Register of Legislation No. F2010L02313) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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\n6 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about anal fissure and death from anal fissure.\n\nMeaning of anal fissure\n\n(2) For the purposes of this Statement of Principles, anal fissure:\n\n(a) means an acquired linear longitudinal split in the skin (anoderm) of the distal anal canal; and\n\n(b) excludes anal inflammatory bowel disease, anal neoplasia and anal infections.\n\n(3) While anal fissure attracts ICD‑10‑AM code K60.0, K60.1 or K60.2, in applying this Statement of Principles the meaning of anal fissure is that given in subsection (2).\n\n(4) 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\nDeath from anal fissure\n\n(5) For the purposes of this Statement of Principles, anal fissure, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's anal fissure.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n8 Basis for determining the factors\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that anal fissure and death from anal fissure 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\n9 Factors that must exist\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, anal fissure or death from anal fissure is connected with the circumstances of a person's relevant service:\n\n(1) having trauma to the anal area at the time of the clinical onset of anal fissure;\n\nNote: trauma to the anal area is defined in the Schedule 1 - Dictionary. \n\n(2) having infection with human immunodeficiency virus before the clinical onset of anal fissure;\n\n(3) straining at stool due to constipation within the two weeks before the clinical onset of anal fissure;\n\n(4) being treated with isotretinoin at the time of the clinical onset of anal fissure;\n\n(5) inability to obtain appropriate clinical management for anal fissure.\n\n10 Relationship to service\n\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\n(2) The factor set out in subsection 9(5) applies only to material contribution to, or aggravation of, anal fissure where the person's anal fissure was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1) if a factor referred to in section 9 applies in relation to a person; and\n\n(2) 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\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 anal fissure—see subsection 7(2).\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 trauma to the anal area means injury to the anal area including by childbirth, laceration by a foreign body, sexual assault and surgical procedure.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the same narrow, specific scope as its 2010 predecessor. It addresses only anal fissure in the context of veterans' compensation claims, with no expansion into broader medical conditions or compensation schemes. The 2019 revision appears to be a routine update based on current medical evidence rather than a scope expansion."},"complexity_factors":["Short, focused instrument (approximately 1,500 words)","Only 7 defined terms in Schedule 1 Dictionary","Clear, numbered list of 5 factors in section 9 with minimal conditional language","Single cross-reference mechanism in section 11 (referring to other Statements of Principles)","Straightforward structure: definitions, application, factors, relationship to service","Limited exceptions: only subsection 9(5) has a specific limitation (applying only to aggravation of pre-existing conditions)","No nested definitions or recursive cross-referencing"],"plain_english_summary":"This rulebook sets the medical criteria used to decide whether Australian veterans or current/former defence personnel can get compensation for anal fissure (or death caused by it) under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act. It requires, on the balance of probabilities, one of five medical links to service (e.g. anal trauma, prior HIV, severe straining, isotretinoin use, or inadequate treatment).\n\nIt replaces the 2010 guidance to ensure consistent, evidence-based decisions."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument replaces the 2010 Statement (s4) but retains the same overall scope: it governs when anal fissure or death from anal fissure can be connected to a person’s relevant service for VEA/MRCA claims (s5, s7). The instrument narrows the clinical meaning of anal fissure with exclusions (s7(2)) and specifies five qualifying factors (s9) plus service‑relation rules (s10); it therefore restates and clarifies criteria rather than expanding or contracting the statutory claim coverage."},"complexity_factors":["Legal causation standard: 'balance of probabilities' (instrument title and s8) — lower than criminal standard but requires evidentiary proof.","Medical definition specificity: narrow clinical definition of 'anal fissure' with explicit exclusions (s7(2)–(4)).","Enumerated qualifying factors: five discrete pathways to establish connection (s9).","Service-relationship requirement: each qualifying factor must be shown to be related to relevant service (s10(1)).","Limited scope for management-related factor: s9(5) applies only to material contribution/aggravation where fissure pre‑existed or was suffered/contracted before/during service but did not arise out of service (s10(2)).","Cross-references to other Statements of Principles: factors referring to other conditions defer to those Statements as in force (s11).","Administrative application: applies to claims under specific statutory provisions (s5) and repeals the prior instrument (s4), requiring practitioners/decision-makers to apply updated text.","Use of external medical coding (ICD-10-AM) as a reference while relying on the instrument's textual definition (s7(3)–(4)).","Defined technical terms in a schedule (Schedule 1) including 'relevant service' and 'terminal event', requiring cross-referencing during claims assessment."],"plain_english_summary":"This instrument sets the medical criteria the Repatriation Medical Authority uses to decide, on the balance of probabilities, when anal fissure (or death from it) is attributable to a person’s relevant service. It lists specific qualifying factors (anal trauma, prior HIV infection, recent straining from constipation, isotretinoin treatment, or inability to obtain appropriate clinical management) and replaces the earlier 2010 statement.\n\nIt affects veterans and Defence members making VEA/MRCA claims: claimants must show at least one listed factor and that the factor is related to their relevant service to be eligible for statutory entitlements."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-anal-fissure-balance-of-probabilities-no-88-of-2019","history":"/api/acts/statement-of-principles-concerning-anal-fissure-balance-of-probabilities-no-88-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-anal-fissure-balance-of-probabilities-no-88-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-anal-fissure-balance-of-probabilities-no-88-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-anal-fissure-balance-of-probabilities-no-88-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-anal-fissure-balance-of-probabilities-no-88-of-2019/documents"}}