{"id":"F2021L00486","name":"Statement of Principles concerning endometriosis (Reasonable Hypothesis) (No. 51 of 2021)","slug":"statement-of-principles-concerning-endometriosis-reasonable-hypothesis-no-51-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440821,"registerId":"F2021L00486-fast-fetch-1775956316155","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning endometriosis (Reasonable Hypothesis) (No. 51 of 2021)","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\nENDOMETRIOSIS (Reasonable Hypothesis)\n\n(No. 51 of 2021)\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 April 2021\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:
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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 endometriosis (Reasonable Hypothesis) (No. 51 of 2021).\n\n2 Commencement\n\n This instrument commences on 24 May 2021.\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 endometriosis No. 41 of 2012 (Federal Register of Legislation No. F2012L01355) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 endometriosis and death from endometriosis.\n\nMeaning of endometriosis\n\n(2) For the purposes of this Statement of Principles, endometriosis:\n\n(a) means a condition in females in which functional endometrial tissue occurs outside the uterus, resulting in clinical symptoms and signs or warranting treatment; and\n\n(b) excludes adenomyosis.\n\nNote: Endometriosis commonly manifests with abdominal pain, a pelvic mass or infertility.\n\n(3) While endometriosis attracts ICD‑10‑AM code N80, in applying this Statement of Principles the meaning of endometriosis 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 endometriosis\n\n(5) For the purposes of this Statement of Principles, endometriosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's endometriosis.\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 endometriosis and death from endometriosis 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 endometriosis or death from endometriosis with the circumstances of a person's relevant service:\n\n(1) having penetrating trauma or surgery involving the site of subsequent endometriosis before the clinical onset of endometriosis;\n\n(2) having a caesarean section within the five years before the clinical onset of endometriosis;\n\n(3) being underweight for a period of at least one year while aged 18 years or younger before the clinical onset of endometriosis;\n\nNote: being underweight is defined in the Schedule 1 - Dictionary.\n\n(4) taking estrogen only menopausal hormone therapy for the three months before the clinical onset of endometriosis;\n\nNote: menopausal hormone therapy is defined in the Schedule 1 - Dictionary.\n\n(5) taking tamoxifen for the six months before the clinical onset of endometriosis;\n\n(6) for parous women only, inability to breast feed for a cumulative period of at least three months before the clinical onset of endometriosis;\n\nNote: The period of breastfeeding could be cumulative over a number of pregnancies.\n\n(7) experiencing severe childhood abuse before the clinical onset of endometriosis;\n\nNote: severe childhood abuse is defined in the Schedule 1 - Dictionary.\n\n(8) having pelvic inflammatory disease or endometritis before the clinical onset of endometriosis;\n\n(9) taking estrogen only menopausal hormone therapy for the three months before the clinical worsening of endometriosis;\n\nNote: menopausal hormone therapy is defined in the Schedule 1 - Dictionary.\n\n(10) taking tamoxifen for the six months before the clinical worsening of endometriosis;\n\n(11) for parous women only, inability to breast feed for a cumulative period of at least three months before the clinical worsening of endometriosis;\n\nNote: The period of breastfeeding could be cumulative over a number of pregnancies.\n\n(12) having pelvic inflammatory disease or endometritis before the clinical worsening of endometriosis;\n\n(13) inability to obtain appropriate clinical management for endometriosis.\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 factors set out in subsections 9(9) to 9(13) apply only to material contribution to, or aggravation of, endometriosis where the person's endometriosis 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 being underweight means having a Body Mass Index (BMI) of 18.5 or less.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\n BMI means W/H2 where:\n\n(a) W is the person's weight in kilograms; and\n\n(b) H is the person's height in metres.\n\n endometriosis—see subsection 7(2).\n\n menopausal hormone therapy means administration of hormone preparations to offset a hormone deficiency following surgically induced or naturally occurring menopause.\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 severe childhood abuse means:\n\n(a) serious physical, emotional, psychological or sexual harm whilst a child aged under 16 years; or\n\n(b) neglect involving a serious failure to provide the necessities for health, physical and emotional development, or wellbeing whilst a child aged under 16 years;\n\n where such serious harm or neglect has been perpetrated by a parent, a care provider, an adult who works with or around that child, or any other adult in contact with that child.\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","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":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement of an existing Statement of Principles (No. 41 of 2012). The scope remains consistent with the original intent: establishing medical factors for veterans' compensation claims for endometriosis. The 2021 version updates medical evidence and refines factors (notably adding severe childhood abuse and clarifying breastfeeding and hormone therapy factors) but does not expand beyond the established framework of determining service-relatedness for this specific condition."},"complexity_factors":["13 distinct factual factors with specific temporal requirements (e.g., 'within five years', 'for the three months before', 'cumulative period of at least three months')","Bifurcated structure distinguishing between 'clinical onset' (factors 1-8) and 'clinical worsening' (factors 9-13) with different applicability rules in section 10(2)","Cross-referencing mechanism in section 11 that incorporates other Statements of Principles by reference for factors involving other injuries or diseases","8 defined terms in Schedule 1, including nested definitions (BMI defined in terms of weight/height formula, then used in 'being underweight' definition)","Exclusion of adenomyosis from the definition of endometriosis in section 7(2)(b)","Specific ICD-10-AM coding reference with edition and ISBN citation in section 7(4)","Conditional limitation in section 10(2) restricting factors 9-13 to pre-existing conditions not arising from service"],"plain_english_summary":"The instrument tells when endometriosis can be plausibly linked to military service by listing 13 medical and life‑course factors that create a “reasonable hypothesis” for service connection. It affects female veterans and current/former defence members seeking compensation under the Veterans’ Entitlements Act 1986 or the Military Rehabilitation and Compensation Act 2004. This update replaces the 2012 guidance and matters because the “reasonable hypothesis” test is a relatively generous threshold for obtaining service‑related benefits."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the earlier 2012 Statement (s4) and sets out a new, enumerated set of operative definitions and factors that determine when a reasonable hypothesis links endometriosis to relevant service (s7–s9; Schedule 1). The text itself does not provide a clause‑by‑clause comparison, but the repeal combined with the newly listed factors and definitions indicates the Statement that will govern claims has been updated; the instrument does not state explicitly whether coverage is broader or narrower than the 2012 version."},"complexity_factors":["Cross-references to primary statutes (VEA and MRCA) and application to claims under those Acts (s3, s5).","Medical definitions and coding reliance (endometriosis definition, ICD‑10‑AM reference) requiring clinical interpretation (s7(2)–(4)).","Multiple time‑bound and conditional factors with differing temporal windows (e.g. caesarean within five years; medication durations) (s9).","Causation threshold framed as a \"reasonable hypothesis\" and requirement that listed factors be related to relevant service—creates interpretive discretion (s9, s10(1)).","Interaction with other Statements of Principles where a factor refers to another injury or disease (s11).","Replaces a prior Statement (repeal) which shifts operative scope and may require reassessment of existing claims (s4).","Defined but broad terms that require factual proof (e.g. \"inability to obtain appropriate clinical management\" and \"severe childhood abuse\") (s9(13); Schedule 1).","Application differences for pre‑existing versus service‑aggravated disease (s10(2))."],"plain_english_summary":"This instrument, made by the Repatriation Medical Authority, sets the medical criteria used to decide whether endometriosis (and death from it) can be reasonably linked to a veteran’s service for claims under the VEA and MRCA (s3, s5, s7). It lists specific clinical and historical factors that must exist to raise a “reasonable hypothesis” (for example, prior pelvic surgery, recent caesarean, certain medications, youth underweight, severe childhood abuse, or lack of appropriate clinical management) and requires those factors be related to the person’s relevant service (s9–s10)."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-endometriosis-reasonable-hypothesis-no-51-of-2021","history":"/api/acts/statement-of-principles-concerning-endometriosis-reasonable-hypothesis-no-51-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-endometriosis-reasonable-hypothesis-no-51-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-endometriosis-reasonable-hypothesis-no-51-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-endometriosis-reasonable-hypothesis-no-51-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-endometriosis-reasonable-hypothesis-no-51-of-2021/documents"}}