{"id":"F2022L01374","name":"Statement of Principles concerning diaphragmatic hernia (Balance of Probabilities) (No. 100 of 2022)","slug":"statement-of-principles-concerning-diaphragmatic-hernia-balance-of-probabilities-no-100-of-2022","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441569,"registerId":"F2022L01374-fast-fetch-1775956838348","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning diaphragmatic hernia (Balance of Probabilities) (No. 100 of 2022)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 22.10.0\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nDIAPHRAGMATIC HERNIA (Balance of Probabilities)\n\n(No. 100 of 2022)\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 21 October 2022\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 Terence Campbell AM
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Application\n\n5 Definitions\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n7 Basis for determining the factors\n\n8 Factors that must exist\n\n9 Relationship to service\n\n10 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 diaphragmatic hernia (Balance of Probabilities) (No. 100 of 2022).\n\n2 Commencement\n\n This instrument commences on 21 November 2022.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 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\n5 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about diaphragmatic hernia and death from diaphragmatic hernia.\n\nMeaning of diaphragmatic hernia\n\n(2) For the purposes of this Statement of Principles, diaphragmatic hernia:\n\n(a) means an acquired protrusion of intra-abdominal tissue through the diaphragm into the thoracic cavity; and\n\n(b) excludes:\n\n(i) congenital diaphragmatic hernia;\n\n(ii) eventration of the diaphragm; and\n\n(iii) hiatus hernia.\n\nDeath from diaphragmatic hernia\n\n(3) For the purposes of this Statement of Principles, diaphragmatic hernia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's diaphragmatic hernia.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n7 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 diaphragmatic hernia and death from diaphragmatic 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\n8 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, diaphragmatic hernia or death from diaphragmatic hernia is connected with the circumstances of a person's relevant service:\n\n(1) having a surgical procedure that involves the affected region of the diaphragm, excluding the oesophageal hiatus, within the 10 years before the clinical onset of diaphragmatic hernia;\n\nNote: Examples of surgical procedures that can involve the affected region of the diaphragm include liver resection, debulking surgery in ovarian cancer, nephrectomy, biopsy of a lesion on the diaphragmatic peritoneum and coronary artery bypass grafting.\n\n(2) having acute trauma to the affected region of the diaphragm before the clinical onset of diaphragmatic hernia;\n\nNote: Examples of acute trauma include falling from a height, motor vehicle accidents and gunshot or stab wounds.\n\n(3) having endometriosis involving the affected region of the diaphragm before the clinical onset of diaphragmatic hernia;\n\n(4) having a surgical procedure that involves the affected region of the diaphragm, excluding the oesophageal hiatus, within the 10 years before the clinical worsening of diaphragmatic hernia;\n\nNote: Examples of surgical procedures that can involve the affected region of the diaphragm include liver resection, debulking surgery in ovarian cancer, nephrectomy, biopsy of a lesion on the diaphragmatic peritoneum and coronary artery bypass grafting.\n\n(5) having acute trauma to the affected region of the diaphragm before the clinical worsening of diaphragmatic hernia;\n\nNote: Examples of acute trauma include falling from a height, motor vehicle accidents and gunshot or stab wounds.\n\n(6) having endometriosis involving the affected region of the diaphragm before the clinical worsening of diaphragmatic hernia;\n\n(7) being pregnant within the 6 weeks before the clinical worsening of diaphragmatic hernia;\n\n(8) inability to obtain appropriate clinical management for diaphragmatic hernia.\n\n9 Relationship to service\n\n(1) The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.\n\n(2) The factors set out in subsections 8(4) to (8) apply only to material contribution to, or aggravation of, diaphragmatic hernia where the person's diaphragmatic hernia was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n10 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 8 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 5\n\n1 Definitions\n\nIn this instrument:\n\n diaphragmatic hernia—see subsection 6(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 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"},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"The instrument defines its own scope as applying to claims under section 120B of the VEA or section 339 of the MRCA (section 4). It does not state that it amends or narrows prior Statements; section 10 expressly preserves application of other Statements of Principles where a listed factor refers to another injury or disease."},"complexity_factors":["Use of a legal causation standard — 'balance of probabilities' for medical causation (section 7).","Narrow clinical definition with explicit exclusions (subsection 6(2)).","Multiple temporal thresholds and different trigger points (e.g. 10‑year window for surgery in sections 8(1) and 8(4); 6 weeks for pregnancy in 8(7)).","Requirement that identified factors be related to the person's relevant service (section 9(1)), creating a two-step factual link: factor then service-relationship.","Interaction and cross-reference to other Statements of Principles where a factor refers to another injury or disease (section 10).","Limited statutory application to claims under specific provisions of the VEA and MRCA (section 4), requiring administrators to map this instrument to claim types.","Definitions and scope determinations in Schedule 1 (eg. 'terminal event', 'relevant service') that affect interpretation.","Notes supply non-exhaustive examples, so case-by-case medical assessment is likely required to apply the factors."],"plain_english_summary":"This Statement of Principles sets out when an acquired diaphragmatic hernia (excluding congenital, eventration and hiatus hernia) is to be treated as connected with a person’s military or veteran service for claims under the VEA or MRCA. It lists specific medical and situational factors (for example, prior diaphragm surgery within ten years, acute trauma, diaphragmatic endometriosis, recent pregnancy, or inability to obtain appropriate care) that, if present, establish causation on the balance of probabilities and guide entitlement decisions."},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument maintains its original narrow scope. It addresses a single medical condition (diaphragmatic hernia) with specific exclusions, consistent with the standard format of Repatriation Medical Authority Statements of Principles. The structure mirrors other SOPs with factors for onset and worsening, and does not expand beyond the established framework for determining service-related medical conditions."},"complexity_factors":["Short, focused instrument (approximately 1,500 words)","Only 5 defined terms in the Dictionary (diaphragmatic hernia, MRCA, relevant service, terminal event, VEA)","Clear, numbered list of 8 factors with minimal cross-referencing","Simple conditional structure: 'at least one of the following factors must exist'","Single explicit exclusion list (subsection 6(2)(b)) covering 3 specific conditions","One nested reference mechanism (section 10) linking to other Statements of Principles","No exceptions to exceptions or deeply nested logic"],"plain_english_summary":"This instrument declares diaphragmatic hernia (and death from it) can be service‑related for claims under the Veterans' Entitlements Act and MRCA, and sets the medical \"gateway\" factors that must be shown to link the condition to service. Key triggers include recent diaphragm surgery, acute diaphragmatic trauma, diaphragmatic endometriosis, recent pregnancy‑related worsening, or lack of access to appropriate treatment.\n\nIt excludes congenital hernia, eventration, and hiatus hernia; claimants must show a relevant factor and a service connection."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-diaphragmatic-hernia-balance-of-probabilities-no-100-of-2022","history":"/api/acts/statement-of-principles-concerning-diaphragmatic-hernia-balance-of-probabilities-no-100-of-2022/history","analysis":"/api/acts/statement-of-principles-concerning-diaphragmatic-hernia-balance-of-probabilities-no-100-of-2022/analysis","conflicts":"/api/acts/statement-of-principles-concerning-diaphragmatic-hernia-balance-of-probabilities-no-100-of-2022/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-diaphragmatic-hernia-balance-of-probabilities-no-100-of-2022/important-cases","documents":"/api/acts/statement-of-principles-concerning-diaphragmatic-hernia-balance-of-probabilities-no-100-of-2022/documents"}}