{"id":"F2022L00943","name":"Statement of Principles concerning hiatus hernia (Reasonable Hypothesis) (No. 60 of 2022)","slug":"statement-of-principles-concerning-hiatus-hernia-reasonable-hypothesis-no-60-of-2022","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441462,"registerId":"F2022L00943-fast-fetch-1775956744997","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning hiatus hernia (Reasonable Hypothesis) (No. 60 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 (Reasonable Hypothesis)\n\n(No. 60 of 2022)\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 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 (Reasonable Hypothesis) (No. 60 of 2022).\n\n2 Commencement\n\n This instrument commences on 25 July 2022.\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 hiatus hernia No. 68 of 2014 (Federal Register of Legislation No. F2014L00924) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that hiatus hernia and death from hiatus hernia 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 hiatus hernia or death from hiatus hernia 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 5 years before the clinical onset of hiatus hernia; \n\n(3) having acute elevation of pressure within the abdominal cavity due to any one of the following:\n\n(a) acute abdomen;\n\n(b) anti-G straining manoeuvre;\n\n(c) lifting heavy weights;\n\n(d) significant gagging or vomiting; or\n\n(e) underwater diving with compressed air;\n\nwithin the 7 days before the clinical onset of hiatus hernia;\n\nNote: acute abdomen is defined in the Schedule 1 – Dictionary.\n\n(4) being overweight or obese for at least the 2 years before the clinical onset of hiatus hernia;\n\nNote: being overweight or obese is defined in the Schedule 1 – Dictionary.\n\n(5) being pregnant at the time of the clinical onset of hiatus hernia;\n\n(6) having chronic elevation of pressure within the abdominal cavity due to ascites or chronic peritoneal dialysis at the time of the clinical onset of hiatus hernia;\n\n(7) having systemic sclerosis at the time of the clinical onset of hiatus hernia;\n\n(8) having kyphosis or kyphoscoliosis of the thoracic spine at the time of the clinical onset of hiatus hernia;\n\n(9) 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(10) having a blunt or penetrating injury, excluding a surgical procedure, to the region of the oesophageal hiatus, within the 5 years before the clinical worsening of hiatus hernia;\n\n(11) having acute elevation of pressure within the abdominal cavity due to any one of the following:\n\n(a) acute abdomen;\n\n(b) anti-G straining manoeuvre;\n\n(c) lifting heavy weights;\n\n(d) significant gagging or vomiting; or\n\n(e) underwater diving with compressed air;\n\nwithin the 7 days before the clinical worsening of hiatus hernia;\n\nNote: acute abdomen is defined in the Schedule 1 – Dictionary.\n\n(12) being overweight or obese for at least the 2 years before the clinical worsening of hiatus hernia;\n\nNote: being overweight or obese is defined in the Schedule 1 – Dictionary.\n\n(13) being pregnant at the time of the clinical worsening of hiatus hernia;\n\n(14) having chronic elevation of pressure within the abdominal cavity due to ascites or chronic peritoneal dialysis at the time of the clinical worsening of hiatus hernia;\n\n(15) having systemic sclerosis at the time of the clinical worsening of hiatus hernia;\n\n(16) having kyphosis or kyphoscoliosis of the thoracic spine at the time of the clinical worsening of hiatus hernia;\n\n(17) 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(9) to 9(17) 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(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 acute abdomen means any severe abdominal condition of abrupt onset, usually associated with pain, due to inflammation, perforation, obstruction, infarction, rupture or other pathology of intra-abdominal organs.\n\n being overweight or obese means having a Body Mass Index (BMI) of 25 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 \n\nhiatus hernia—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 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 replaces the 2014 version with updated medical factors but does not expand beyond the established framework of determining service connection for specific diseases under the veterans' compensation scheme. The structure — covering both onset and aggravation with defined factors and temporal windows — is consistent with the original legislative intent under subsection 196B(2) of the Veterans' Entitlements Act 1986."},"complexity_factors":["Moderate cross-referencing: 8 defined terms in Schedule 1, with some terms (BMI, MRCA, VEA) requiring nested definitions","Parallel structure duplication: Factors 1-8 apply to 'clinical onset' while factors 9-16 mirror them for 'clinical worsening', creating near-identical conditional blocks","Temporal complexity: Multiple overlapping time windows (2 years, 5 years, 7 days, 'at the time of') that must be precisely tracked","Conditional logic in section 10(2): Restricts factors 9-17 to aggravation cases only where hernia pre-existed service","Incorporation by reference: Section 11 creates dynamic links to other Statements of Principles that change 'as in force from time to time'","Medical terminology requiring definition: 'acute abdomen', 'systemic sclerosis', 'kyphoscoliosis', 'anti-G straining manoeuvre'"],"plain_english_summary":"This Statement of Principles guides when hiatus hernia in Australian veterans and defence members is considered connected to service for compensation, using the lower \"reasonable hypothesis\" standard and replacing the 2014 version. It affects claimants under the Veterans' Entitlements Act and MRCA and the DVA decision-makers who assess them.\n\nIt identifies medical and factual circumstances that can link acquired hiatus hernia to service (e.g., recent diaphragm surgery, chest/abdominal injury, sudden abdominal pressure, obesity, pregnancy), and notes some factors pertain only to worsening, not initial causation."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"Yes. This instrument expressly repeals the 2014 Statement (s4) and replaces it with an updated set of factors, timeframes and definitions that determine when hiatus hernia (or death from it) may be linked to relevant service (s7, s9–10, Schedule 1). It clarifies exclusions and distinguishes criteria for onset versus clinical worsening and for pre‑existing conditions (s9; s10(2))."},"complexity_factors":["Multiple medical factors with differing look‑back windows and thresholds (timeframes in s9: 2 years, 5 years, 7 days, etc.)","Interplay between criteria for onset versus clinical worsening, and distinct application where condition pre‑existed service (s9; s10(2))","Cross‑reference to other Statements of Principles when factors overlap, requiring consultation of additional instruments (s11)","Defined exclusions and technical medical definitions (congenital exclusion, acute abdomen, BMI formula) that require expert interpretation (s7(2)(c); Schedule 1)","Repeal of the earlier 2014 Statement creates a change of authoritative criteria to be applied to claims (s4)","Evidentiary and administrative burden on claimants to establish the listed factors and relation to service; decision makers exercise evaluative judgment to form a 'reasonable hypothesis' (s9–10)","Potential for diagnostic ambiguity (many patients asymptomatic) increasing reliance on clinical records and specialist opinion (notes to s7; s9)"],"plain_english_summary":"This Statement of Principles sets the medical criteria used to decide whether a hiatus hernia—or death contributed to by it—can be linked to a person's relevant military service and replaces the 2014 Statement (s4–5). It lists specific clinical and exposure factors with time limits (s9)—for example, recent surgery or injury to the oesophageal hiatus, acute or chronic intra‑abdominal pressure events, BMI≥25, pregnancy and certain diseases—and requires those factors be related to service (s10). Claimants must produce medical evidence; decision‑makers apply these criteria to form a ‘reasonable hypothesis’."},"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-reasonable-hypothesis-no-60-of-2022","history":"/api/acts/statement-of-principles-concerning-hiatus-hernia-reasonable-hypothesis-no-60-of-2022/history","analysis":"/api/acts/statement-of-principles-concerning-hiatus-hernia-reasonable-hypothesis-no-60-of-2022/analysis","conflicts":"/api/acts/statement-of-principles-concerning-hiatus-hernia-reasonable-hypothesis-no-60-of-2022/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-hiatus-hernia-reasonable-hypothesis-no-60-of-2022/important-cases","documents":"/api/acts/statement-of-principles-concerning-hiatus-hernia-reasonable-hypothesis-no-60-of-2022/documents"}}