{"id":"F2022L00944","name":"Statement of Principles concerning hiatus hernia (Balance of Probabilities) (No. 61 of 2022)","slug":"statement-of-principles-concerning-hiatus-hernia-balance-of-probabilities-no-61-of-2022","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441463,"registerId":"F2022L00944-fast-fetch-1775956745021","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning hiatus hernia (Balance of Probabilities) (No. 61 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\nHIATUS HERNIA (Balance of Probabilities)\n\n(No. 61 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 24 June 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:
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Professor Terence Campbell AM
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 hiatus hernia (Balance of Probabilities) (No. 61 2022).\n\n2 Commencement\n\n This instrument commences on 25 July 2022.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning hiatus hernia No. 69 of 2014 (Federal Register of Legislation No. F2014L00925) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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\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 hiatus hernia and death from hiatus hernia.\n\nMeaning of hiatus hernia\n\n(2) For the purposes of this Statement of Principles, hiatus hernia:\n\n(a) means an acquired protrusion of intra-abdominal tissue through the oesophageal hiatus of the diaphragm into the thoracic cavity; and\n\n(b) includes:\n\n(i) mixed sliding and paraoesophageal hiatus hernia;\n\n(ii) paraoesophageal hiatus hernia; and\n\n(iii) sliding hiatus hernia; and\n\n(c) excludes:\n\n(i) congenital hiatus hernia;\n\n(ii) eventration of the diaphragm; and \n\n(iii) physiological herniation during swallowing.\n\nNote 1: Hiatus hernia is also known as hiatal hernia, and can be classified as type I, II, III or IV.\n\nNote 2: Most patients are asymptomatic. The clinical features of hiatus hernia can include heartburn, regurgitation, chest pain, postprandial fullness, nausea and retching.\n\nDeath from hiatus hernia\n\n(3) For the purposes of this Statement of Principles, hiatus hernia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's hiatus hernia.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n8 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 hiatus hernia and death from hiatus 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\n9 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, hiatus hernia or death from hiatus hernia is connected with the circumstances of a person's relevant service:\n\n(1) having a surgical procedure that involves the region of the oesophageal hiatus or affects the structures supporting the oesophageal hiatus, within the 2 years before the clinical onset of hiatus hernia;\n\nNote: Examples of surgical procedures that can involve the region of the oesophageal hiatus or affect the structures supporting the oesophageal hiatus include bariatric surgery, coronary artery bypass grafting, gastrectomy, oesophagectomy and pulmonary lobe resection.\n\n(2) having a blunt or penetrating injury, excluding a surgical procedure, to the region of the oesophageal hiatus, within the 2 years before the clinical onset of hiatus hernia;\n\n(3) being obese for at least the 2 years before the clinical onset of hiatus hernia;\n\nNote: being obese is defined in the Schedule 1 – Dictionary.\n\n(4) being pregnant at the time of the clinical onset of hiatus hernia;\n\n(5) having a surgical procedure that involves the region of the oesophageal hiatus or affects the structures supporting the oesophageal hiatus, within the 2 years before the clinical worsening of hiatus hernia;\n\nNote: Examples of surgical procedures that can involve the region of the oesophageal hiatus or affect the structures supporting the oesophageal hiatus include bariatric surgery, coronary artery bypass grafting, gastrectomy, oesophagectomy and pulmonary lobe resection.\n\n(6) having a blunt or penetrating injury, excluding a surgical procedure, to the region of the oesophageal hiatus, within the 2 years before the clinical worsening of hiatus hernia;\n\n(7) being obese for at least the 2 years before the clinical worsening of hiatus hernia;\n\nNote: being obese is defined in the Schedule 1 – Dictionary.\n\n(8) being pregnant at the time of the clinical worsening of hiatus hernia;\n\n(9) inability to obtain appropriate clinical management for hiatus hernia.\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(5) to 9(9) apply only to material contribution to, or aggravation of, hiatus hernia where the person's hiatus hernia 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(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 6\n\n1 Definitions\n\nIn this instrument:\n\n being obese means having a Body Mass Index (BMI) of 30 or greater.\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 hiatus hernia—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 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":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the standard scope of Repatriation Medical Authority Statements of Principles. It provides a focused, condition-specific framework for determining service connection for hiatus hernia claims, consistent with the original legislative intent under subsection 196B(3) of the Veterans' Entitlements Act 1986. The 2022 revision updates the 2014 version but does not expand beyond the established purpose of setting medical evidentiary standards for veterans' compensation claims."},"complexity_factors":["Multiple temporal requirements (2-year lookback periods for onset and worsening)","Parallel structure for onset vs. worsening factors (subsections 9(1)-(4) mirror 9(5)-(8))","Cross-referencing mechanism in section 11 to other Statements of Principles","Conditional limitation in section 10(2) restricting factors 5-9 to pre-existing conditions aggravated by service","Mathematical formula for BMI definition in Schedule 1","Exclusionary definitions in section 7(2)(c) (congenital, eventration, physiological herniation)","Inclusion of death scenarios through 'terminal event' definition requiring proximate cause analysis"],"plain_english_summary":"This Statement of Principles updates the medical rules for deciding whether hiatus hernia is service-related for veterans and current/former defence members, replacing the 2014 version. It sets the \"balance of probabilities\" test and guides DVA decision-makers on compensability.\n\nIt identifies nine qualifying factors that can connect the condition to service — for example prior surgery or injury near the diaphragm, obesity, pregnancy, or lack of timely treatment — and clarifies when worsening of a pre‑existing hernia is service‑related."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2014 Statement of Principles (s.4) and replaces it with a Statement that: applies to claims under the VEA s.120B and MRCA s.339 (s.5); specifies which types of hiatus hernia are covered and which are excluded (s.7(2)); sets a BMI≥30 definition and BMI formula (Schedule 1); imposes 2‑year temporal windows for surgical or traumatic causes and for worsening (s.9); and expressly includes inability to obtain appropriate clinical management as a qualifying factor (s.9(9))."},"complexity_factors":["Temporal windows and distinction between clinical onset and clinical worsening (2‑year limits) create timing-sensitive causation tests (s.9).","Requirement that listed factor(s) be related to the person's relevant service places evidential burden on claimants (s.10).","Cross-application to other Statements of Principles introduces inter-instrument dependency and possible overlapping criteria (s.11).","Technical medical definitions and inclusion/exclusion rules (definition of hiatus hernia, exclusions for congenital/eventration/physiological swallowing) require clinical interpretation (s.7(2)).","Objective BMI threshold and BMI calculation formalise obesity as a qualifying factor but require measured weight/height evidence (Schedule 1).","Inclusion of death via contribution to a terminal event expands scope to proximate/ultimate causes and listed terminal events (Schedule 1).","Application limited to statutory claim pathways (VEA s.120B and MRCA s.339) narrows operational context for decision‑makers and claimants (s.5).","Repeal and replacement of the prior Statement may require administrative updates and comparability checks (s.4)."],"plain_english_summary":"This Statement of Principles sets out the medical criteria the Repatriation Medical Authority uses to decide when hiatus hernia (and death from it) can be connected to a veteran's or defence member's relevant service. It lists specific qualifying factors — e.g. surgery or injury near the oesophageal hiatus, obesity (BMI ≥30), pregnancy, or inability to obtain appropriate management — with 2‑year timing windows for onset or worsening (s.9). It applies to claims under the VEA or MRCA (s.5) and requires proof that at least one factor is related to the person's relevant service (s.10)."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-hiatus-hernia-balance-of-probabilities-no-61-of-2022","history":"/api/acts/statement-of-principles-concerning-hiatus-hernia-balance-of-probabilities-no-61-of-2022/history","analysis":"/api/acts/statement-of-principles-concerning-hiatus-hernia-balance-of-probabilities-no-61-of-2022/analysis","conflicts":"/api/acts/statement-of-principles-concerning-hiatus-hernia-balance-of-probabilities-no-61-of-2022/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-hiatus-hernia-balance-of-probabilities-no-61-of-2022/important-cases","documents":"/api/acts/statement-of-principles-concerning-hiatus-hernia-balance-of-probabilities-no-61-of-2022/documents"}}