{"id":"F2026L00143","name":"Statement of Principles concerning haemorrhoids (Reasonable Hypothesis) (No. 19 of 2026)","slug":"statement-of-principles-concerning-haemorrhoids-reasonable-hypothesis-no-19-of-2026","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":443151,"registerId":"F2026L00143-fast-fetch-1775958063997","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning haemorrhoids (Reasonable Hypothesis) (No. 19 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  (Reasonable Hypothesis)\n\n(No. 19 of 2026)\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 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   \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 (Reasonable Hypothesis) (No. 19 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(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning haemorrhoids (Reasonable Hypothesis) (No. 3 of 2017) (Federal Register of Legislation No. F2017L00004) made under subsection 196B(2) of the VEA is repealed.\n\n1.                Application\n\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\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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that haemorrhoids and death from haemorrhoids 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\n1.                Factors that must exist\n\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 haemorrhoids or death from haemorrhoids 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.           having a pelvic space occupying lesion of sufficient size to impinge on the rectal veins at clinical onset or clinical worsening;\n\n\nNote: pelvic space occupying lesions are intended to include tumours outside the pelvis but in the region of the rectal veins sufficiently large to impede rectal vein blood flow. Tumours could include but are not limited to anal, rectal, bowel, bladder, ureter, urethral, prostate, ovarian, cervical and pelvic bone osteosarcoma.\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.           having irritable bowel syndrome for at least the 3 months before clinical onset;\n2.           having irritable bowel syndrome for at least the 4 weeks before clinical worsening;\n3.       having receptive anal intercourse within the 48 hours before clinical worsening;\n4.       taking anticoagulants, antiplatelet agents, or nonsteroidal anti-inflammatory drugs within the 30 days before hemorrhoidal bleeding;\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(2) 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)          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 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_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2017 Statement (s4) and replaces it with a Statement that expressly defines haemorrhoids and death from haemorrhoids (s7), and lists a revised set of service‑related factors and precise time windows (s9). New or emphasised items include pregnancy timing, quantified fibre‑intake thresholds, khat use, pelvic space‑occupying lesions, spinal cord injury, medication exposures, receptive anal intercourse, and inability to obtain appropriate clinical management. It thereby alters the evidentiary criteria decision‑makers must apply when assessing causation for VEA/MRCA claims (s1, s5, s10)."},"complexity_factors":["Multiple, discrete medical factors with different temporal thresholds to establish a 'reasonable hypothesis' (see s9)","Inclusion of both incident and clinical-worsening pathways, with differing time windows for onset and worsening (s9, s10(2))","Detailed medical definitions and exclusions (haemorrhoids definition and exclusion of anorectal varices, s7(2))","Cross-reference to other Statements of Principles where a factor refers to another injury/disease (s11)","New specific quantitative nutritional threshold (20 g fibre/day) with two separate temporal tests (s9; Schedule 1)","Addition of death from haemorrhoids via terminal events, bringing cause-of-death issues into scope (s7(4); Schedule 1 terminal event)","Use of pharmacological categories and non-medical exposures (anticoagulants, antiplatelet agents, khat, receptive anal intercourse) requiring evidentiary proof (s9; Schedule 1)","Repeal of the prior instrument and replacement creates transitional/administrative considerations for decision-makers (s4)","Bureaucratic discretion in linking listed factors to the person’s relevant service (s10(1))"],"plain_english_summary":"Mechanically, this instrument repeals the 2017 Statement and replaces it with a new Statement of Principles that defines haemorrhoids (and death from haemorrhoids) and sets a list of medical factors and time limits that, if present, raise a reasonable hypothesis the condition is related to a person’s relevant military service. It applies to claims under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act and therefore affects veterans, serving members and decision makers by specifying the clinical and temporal evidence used to link haemorrhoids to service."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a routine reissue of an existing Statement of Principles. It replaces the 2017 version (No. 3 of 2017) with updated medical evidence but maintains the same fundamental scope: establishing medical criteria for linking haemorrhoids to military service. The structure and purpose remain consistent with the original legislative intent under subsection 196B(2) of the Veterans' Entitlements Act 1986."},"complexity_factors":["Multiple defined terms in Schedule 1 (9 explicit definitions including nested definitions where terms refer to other defined terms)","Temporal requirements vary significantly between factors (ranging from 48 hours to 3 months)","Distinction between 'clinical onset' and 'clinical worsening' with different time periods applying to each","Cross-referencing between this instrument and other Statements of Principles via section 11","Dual legislative framework application (VEA and MRCA with different service definitions)","Specific exclusion of anorectal varices from the definition despite similar ICD-10-AM coding","Conditional logic in section 10(2) limiting worsening claims to pre-existing conditions not arising from service"],"plain_english_summary":"This instrument updates the 2017 medical guidance and sets when haemorrhoids can be reasonably linked to military service for claims under the Veterans' Entitlements Act and MRCA. It specifies 12 medical factors that, if present and connected to service, create a “reasonable hypothesis” that the condition was caused or worsened by service.\n\nIt affects current and former ADF members, veterans, peacekeepers and their families (for death benefits), and makes it easier to establish service connection without absolute medical certainty."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-haemorrhoids-reasonable-hypothesis-no-19-of-2026","history":"/api/acts/statement-of-principles-concerning-haemorrhoids-reasonable-hypothesis-no-19-of-2026/history","analysis":"/api/acts/statement-of-principles-concerning-haemorrhoids-reasonable-hypothesis-no-19-of-2026/analysis","conflicts":"/api/acts/statement-of-principles-concerning-haemorrhoids-reasonable-hypothesis-no-19-of-2026/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-haemorrhoids-reasonable-hypothesis-no-19-of-2026/important-cases","documents":"/api/acts/statement-of-principles-concerning-haemorrhoids-reasonable-hypothesis-no-19-of-2026/documents"}}