{"id":"F2025L00969","name":"Statement of Principles concerning hookworm infection (Balance of Probabilities) (No. 68 of 2025)","slug":"statement-of-principles-concerning-hookworm-infection-balance-of-probabilities-no-68-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442928,"registerId":"F2025L00969-fast-fetch-1775957846098","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning hookworm infection (Balance of Probabilities) (No. 68 of 2025)","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\nHOOKWORM INFECTION  (Balance of Probabilities)\n\n(No. 68 of 2025)\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 22 August 2025\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 hookworm infection (Balance of Probabilities) (No. 68 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 22 September 2025.\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 hookworm disease (Balance of Probabilities) (No. 8 of 2017) (Federal Register of Legislation No. F2017L00012) made under subsection 196B(3) of the VEA is repealed.\n\n1.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 hookworm infection and death from hookworm infection.\n\n\nMeaning of hookworm infection\n\n1.           For the purposes of this Statement of Principles, hookworm infection:\n  1.           means an infection with the parasitic hookworm Necator americanus, Ancylostoma duodenale, Ancylostoma ceylanicum, Ancylostoma caninum, Ancylostoma braziliense, Ancylostoma tubaeforme, Uncinaria stenocephela, or Bunostomum phlebotomum; and\n  2.           includes intestinal hookworm infection and extraintestinal hookworm infection (cutaneous larva migrans).\n\n\nNote 1: Intestinal hookworm infection is caused by Necator americanus, Ancylostoma duodenale, and Ancylostoma ceylancium.\n\nNote 2: Extraintestinal hookworm infection is commonly caused by zoonotic species, primarily Ancylostoma canium and Ancylostoma brazilense.\n\n1.           While hookworm infection attracts ICD‑10‑AM code B76, in applying this Statement of Principles the meaning of hookworm infection 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 hookworm infection\n\n1.           For the purposes of this Statement of Principles, hookworm infection, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's hookworm infection.\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 hookworm infection and death from hookworm infection 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, hookworm infection or death from hookworm infection is connected with the circumstances of a person's relevant service:\n\n1.           being exposed to Necator americanus, Ancylostoma duodenale, Ancylostoma ceylanicum, Ancylostoma caninum, Ancylostoma braziliense, Ancylostoma tubaeforme, Uncinaria stenocephela, or Bunostomum phlebotomum as a result of:\n  1.           being in contact with soil or sand contaminated with larvae; or\n  2.           being in contact with human or animal faeces contaminated with larvae; or\n  3.           ingesting food, drink or dust contaminated with larvae; or\n  4.           being in a tropical or subtropical region with poor sanitation; or\n  5.           being in warm and damp conditions with poor sanitation;\n\n\nwithin the 6 years before clinical onset;\n\n1.           inability to obtain appropriate clinical management for hookworm infection 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 factor set out in subsection 9(2) applies only to material contribution to, or aggravation of, hookworm infection where the person's hookworm infection 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                               hookworm infection—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":{"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"},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"The instrument maintains the standard scope of Repatriation Medical Authority Statements of Principles. It updates the 2017 version by expanding the definition of hookworm infection to explicitly include additional species (Ancylostoma tubaeforme, Uncinaria stenocephela, Bunostomum phlebotomum) and clarifying the distinction between intestinal and extraintestinal forms, but this represents medical-scientific updating rather than scope creep beyond the original purpose of determining service connection for hookworm-related claims."},"complexity_factors":["Short, self-contained instrument (approximately 1,500 words)","Only 6 defined terms in the Dictionary (Schedule 1)","Simple binary structure: one exposure-based factor (section 9(1)) and one clinical management factor (section 9(2))","Limited cross-referencing—only refers to other Statements of Principles in section 11, and standard definitions (VEA, MRCA, relevant service)","Clear temporal limitation ('within the 6 years before clinical onset')","No nested exceptions or conditional logic beyond the basic 'at least one factor' requirement","Straightforward relationship-to-service test in section 10"],"plain_english_summary":"This medical-legal rulebook sets the criteria for Australian veterans and current/former defence personnel to claim compensation for hookworm infection, replacing the 2017 version. It defines hookworm broadly—including intestinal and animal-derived skin infections—and requires a balance-of-probabilities link between service exposure (e.g., in warm, unsanitary environments) or lack of treatment and later disease, standardising how service-related hookworm claims are assessed across veterans’ compensation schemes."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2017 Statement (s.4) and replaces it with updated scope: it specifies constituent hookworm species and explicitly includes extra‑intestinal infection and death (s.7(2)–(4)), sets concrete exposure pathways and a 6‑year exposure window (s.9(1)), and adds lack of access to appropriate clinical management as a qualifying factor (s.9(2)). It continues to apply to claims under the VEA and MRCA (s.5)."},"complexity_factors":["Detailed species list and inclusion of extra‑intestinal (cutaneous) infections (s.7(2) and Notes)","Specified exposure pathways with a strict 6‑year exposure‑to‑clinical‑onset window (s.9(1)(a) and s.9(1))","Non‑exposure qualifying factor: inability to obtain appropriate clinical management before clinical worsening (s.9(2))","Requirement that any listed factor be related to the person's relevant service (s.10(1)) and special rule for pre‑existing infection (s.10(2))","Integration with other Statements of Principles where factors overlap (s.11)","Inclusion of death via defined terminal events and cross‑reference to Schedule definitions (s.7(4); Schedule)","Repeal of the 2017 Statement and a clear commencement date (s.4; s.2)","References to statutory standards and classification (ICD‑10‑AM) rather than clinical guidelines (s.7(3))"],"plain_english_summary":"This Statement of Principles tells how the Repatriation Medical Authority will decide if a hookworm infection (including specified human and zoonotic species, intestinal and cutaneous forms) is connected to a person’s military or veteran service for claims under the Veterans' Entitlements Act or MRCA. It lists specific exposure pathways, a six‑year exposure‑to‑onset window, inability to obtain appropriate clinical management as a qualifying factor, and treats death from hookworm via defined terminal events as included. It governs entitlement decisions on the balance of probabilities."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-hookworm-infection-balance-of-probabilities-no-68-of-2025","history":"/api/acts/statement-of-principles-concerning-hookworm-infection-balance-of-probabilities-no-68-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-hookworm-infection-balance-of-probabilities-no-68-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-hookworm-infection-balance-of-probabilities-no-68-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-hookworm-infection-balance-of-probabilities-no-68-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-hookworm-infection-balance-of-probabilities-no-68-of-2025/documents"}}