{"id":"F2026L00144","name":"Statement of Principles concerning haemorrhoids (Balance of Probabilities) (No. 20 of 2026)","slug":"statement-of-principles-concerning-haemorrhoids-balance-of-probabilities-no-20-of-2026","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":443154,"registerId":"F2026L00144-fast-fetch-1775958066100","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning haemorrhoids (Balance of Probabilities) (No. 20 of 2026)","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\nHAEMORRHOIDS  (Balance of Probabilities)\n\n(No. 20 of 2026)\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 20 February 2026\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 haemorrhoids (Balance of Probabilities) (No. 20 of 2026).\n\n1.                Commencement\n\n\n              This instrument commences on 23 March 2026.\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 haemorrhoids (Balance of Probabilities) (No. 4 of 2017) (Federal Register of Legislation No. F2017L00005) made under subsection 196B(3) of the VEA is repealed.\n\n1.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 haemorrhoids and death from haemorrhoids.\n\n\nMeaning of haemorrhoids\n\n1.           For the purposes of this Statement of Principles, haemorrhoids:\n  1.           means inflammation, bleeding, thrombosis, prolapse or symptomatic enlargement of the haemorrhoidal cushions; and\n  2.           excludes anorectal varices.\n\n\nNote: clinical worsening of haemorrhoids may include an increase in the grade of the haemorrhoids, bleeding and/or the need for surgical intervention.\n\n1.           While haemorrhoids attracts ICD‑10‑AM code K64, O22.4 or O87.2, in applying this Statement of Principles the meaning of haemorrhoids 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 haemorrhoids\n\n1.           For the purposes of this Statement of Principles, haemorrhoids, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's haemorrhoids.\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 haemorrhoids and death from haemorrhoids 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, haemorrhoids or death from haemorrhoids is connected with the circumstances of a person's relevant service:\n\n1.           being pregnant within the 6 weeks before clinical onset or clinical worsening;\n2.           straining at stool due to constipation or diarrhoea, within the 2 weeks before clinical onset or clinical worsening;\n3.           having a spinal cord injury at the time of the clinical onset or clinical worsening;\n\n\nNote: spinal cord injury is defined in the Schedule 1 - Dictionary. \n\n1.           chewing khat at least weekly, for at least the 3 months before clinical onset or clinical worsening;\n2.           an inability to consume an average daily intake of 20 grams of fibre in food for at least the 3 months before clinical onset;\n\n\nNote: fibre in food is defined in the Schedule 1 - Dictionary.\n\n1.           an inability to consume an average daily intake of 20 grams of fibre in food for at least the 4 weeks before clinical worsening;\n\n\nNote: fibre in food is defined in the Schedule 1 - Dictionary.\n\n1.           taking anticoagulants, antiplatelet agents, or nonsteroidal anti-inflammatory drugs within the 30 days before hemorrhoidal bleeding for clinical worsening;\n\n\nNote: anticoagulants, antiplatelet agents are defined in the Schedule 1 – Dictionary.\n\n1.           inability to obtain appropriate clinical management for haemorrhoids 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, haemorrhoids where the person's haemorrhoids 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                             anticoagulants means pharmacological agents which suppress, delay or attenuate blood coagulation, including heparin, warfarin, dicumarol, dabigatran, apixaban, and rivaroxaban.\n\n                             antiplatelet agents means pharmacological agents that block platelet adhesion or aggregation, including aspirin, clopidogrel, dipyridamole, monoclonal antibodies and peptides.\n\n                             fibre in food means complex carbohydrates of plant origin consumed as vegetables, fruits or cereals which resist digestion by gastrointestinal enzymes in the gastrointestinal tract, and include plant cell walls and non-starch polysaccharides from sources other than cell walls, including cellulose and pectins.\n\n                               haemorrhoids—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                               spinal cord injury means a partial or complete spinal cord injury causing motor and/or sensory deficits below the level of the lesion.\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":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals and replaces the Statement of Principles concerning haemorrhoids (No. 4 of 2017) (s4), so the operative Statement governing haemorrhoids claims has changed. The instrument itself sets the new operative criteria (s7–s11, Schedule 1) but does not state, within the text, a comparison of substantive differences to the 2017 version; therefore whether the substantive scope widened or narrowed cannot be determined from this instrument alone."},"complexity_factors":["Statutory cross‑references to benefits schemes (VEA, MRCA) and authority to make Statements (s3, s5)","Balance‑of‑probabilities causation standard with a discrete list of qualifying factors (s8, s9)","Multiple temporal thresholds and clinical‑worsening rules (e.g. 6 weeks, 2 weeks, 3 months, 4 weeks, 30 days) that affect eligibility (s9)","Defined medical and pharmacological terms with examples in Schedule 1 (anticoagulants, antiplatelet agents, fibre in food, spinal cord injury, terminal event)","Interaction with other Statements of Principles: factors that refer to other conditions adopt those other Statements' terms (s11)","Interpretive constraint that clinical worsening applies only where condition was suffered or contracted before/during but did not arise out of service (s10(2))"],"plain_english_summary":"This Repatriation Medical Authority instrument (s3) sets the medical criteria used to decide, on the balance of probabilities, when haemorrhoids (and death from them) are connected to a veteran’s or member’s service for claims under the VEA or MRCA (s5, s8). Claimants must show at least one listed causal factor (s9) and a link to relevant service (s10); key definitions and time thresholds are in Schedule 1. The instrument also repeals the 2017 Statement (s4)."},"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 is a straightforward reissue/replacement of a 2017 Statement of Principles on the same specific medical condition (haemorrhoids). The scope remains tightly focused on establishing the causal connection between haemorrhoids and military service for compensation purposes, which is the original and continuing purpose of all Repatriation Medical Authority Statements of Principles."},"complexity_factors":["Short, focused instrument (approximately 1,500 words)","Only 9 defined terms in the Dictionary (Schedule 1)","Clear, numbered list of 8 factors in section 9 with minimal cross-referencing","Simple conditional structure: 'at least one factor must exist' before connection to service can be established","Single nested concept in section 10(2) regarding clinical worsening of pre-existing conditions","Straightforward repeal and commencement provisions","Limited external references (only to ICD-10-AM coding system and other Statements of Principles)"],"plain_english_summary":"This instrument replaces the 2017 rules and sets when haemorrhoids (piles) can be treated as service-related for veterans’ compensation, applying the “balance of probabilities” test. It affects claimants under the Veterans’ Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004 by listing service-linked circumstances (e.g. pregnancy, straining, spinal injury, substance use, low fibre, certain medications, or lack of treatment) that can establish causation, and also covers death where haemorrhoids contributed."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-haemorrhoids-balance-of-probabilities-no-20-of-2026","history":"/api/acts/statement-of-principles-concerning-haemorrhoids-balance-of-probabilities-no-20-of-2026/history","analysis":"/api/acts/statement-of-principles-concerning-haemorrhoids-balance-of-probabilities-no-20-of-2026/analysis","conflicts":"/api/acts/statement-of-principles-concerning-haemorrhoids-balance-of-probabilities-no-20-of-2026/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-haemorrhoids-balance-of-probabilities-no-20-of-2026/important-cases","documents":"/api/acts/statement-of-principles-concerning-haemorrhoids-balance-of-probabilities-no-20-of-2026/documents"}}