{"id":"F2019L01089","name":"Statement of Principles concerning anal fissure (Reasonable Hypothesis) (No. 87 of 2019)","slug":"statement-of-principles-concerning-anal-fissure-reasonable-hypothesis-no-87-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440201,"registerId":"F2019L01089-fast-fetch-1775955919746","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning anal fissure (Reasonable Hypothesis) (No. 87 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 (Reasonable Hypothesis)\n\n(No. 87 of 2019)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) 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 (Reasonable Hypothesis) (No. 87 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning anal fissure No. 73 of 2010 (Federal Register of Legislation No. F2010L02312) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that anal fissure and death from anal fissure 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.\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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting anal fissure or death from anal fissure 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(2) 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) operational service under the VEA;\n\n(b) peacekeeping service under the VEA;\n\n(c) hazardous service under the VEA;\n\n(d) British nuclear test defence service under the VEA;\n\n(e) warlike service under the MRCA; or\n\n(f) non-warlike 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":{"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the same narrow scope as its 2010 predecessor and the standard template for Repatriation Medical Authority Statements of Principles. It addresses only anal fissure and death resulting from it, with no expansion into related conditions or broader policy areas. The scope remains tightly confined to establishing the causal factors for this specific condition in the veterans' compensation context."},"complexity_factors":["Short, focused instrument (approximately 1,500 words) dealing with a single medical condition","Only 7 defined terms in the Dictionary (Schedule 1)","Simple structure: 11 sections plus a short dictionary","Clear, enumerated list of 5 factors in section 9 with minimal cross-referencing","Single conditional limitation in section 10(2) restricting factor 9(5) to aggravation cases only","No nested exceptions or complex definitional chains","Straightforward incorporation of external medical classification (ICD-10-AM) with specific edition citation"],"plain_english_summary":"This instrument sets when anal fissure can be accepted as caused by military service for claims under the Veterans' Entitlements Act and MRCA, replacing the 2010 rules. It affects veterans, current/former ADF members, and DVA decision-makers.\n\nAcceptance requires at least one specified medical or situational factor linking the fissure to service (e.g., local trauma, prior HIV, recent severe constipation, isotretinoin use, or lack of timely treatment). It applies the lower “reasonable hypothesis” test, easing claim success compared with balance-of-probabilities."},"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"},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"Section 4 repeals the earlier Statement of Principles No. 73 of 2010. This instrument replaces that prior Statement and specifies the condition's definition, the factors that raise a reasonable hypothesis of service connection, and that it applies to claims under section 120A of the VEA or section 338 of the MRCA (s5, s7, s9)."},"complexity_factors":["Cross‑references to Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004 (s3, s5)","Defined medical term and exclusions (detailed definition of 'anal fissure' at s7(2) and ICD‑10‑AM code reference at s7(3)-(4))","Use of a legal causation threshold ('reasonable hypothesis') rather than a numerical probability","Short enumerated checklist of causative or contributing factors (s9) with timing limits (eg. two weeks for straining)","Special rule for inability to obtain treatment applying only to material contribution/aggravation of pre‑existing disease (s10(2) referencing s9(5))","Interaction with other Statements of Principles where a listed factor refers to another injury/disease (s11)","Repeal of a prior Statement (s4), requiring administrators to apply the new instrument from commencement (s2)"],"plain_english_summary":"This instrument sets out the Repatriation Medical Authority’s Statement of Principles for anal fissure. It defines the medical condition, specifies the medical and service‑related factors that, if present, raise a \"reasonable hypothesis\" linking anal fissure (or death from it) to a person’s relevant service, and applies to claims under the VEA and MRCA.\n\nIt affects veterans and service members seeking entitlements: decision‑makers use the listed factors to decide whether service connection is reasonably raised and what evidence is required to support a claim."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-anal-fissure-reasonable-hypothesis-no-87-of-2019","history":"/api/acts/statement-of-principles-concerning-anal-fissure-reasonable-hypothesis-no-87-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-anal-fissure-reasonable-hypothesis-no-87-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-anal-fissure-reasonable-hypothesis-no-87-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-anal-fissure-reasonable-hypothesis-no-87-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-anal-fissure-reasonable-hypothesis-no-87-of-2019/documents"}}