{"id":"F2025L00968","name":"Statement of Principles concerning hookworm infection (Reasonable Hypothesis) (No. 67 of 2025)","slug":"statement-of-principles-concerning-hookworm-infection-reasonable-hypothesis-no-67-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442927,"registerId":"F2025L00968-fast-fetch-1775957846095","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning hookworm infection (Reasonable Hypothesis) (No. 67 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  (Reasonable Hypothesis)\n\n(No. 67 of 2025)\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 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   \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 (Reasonable Hypothesis) (No. 67 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(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning hookworm disease (Reasonable Hypothesis) (No. 7 of 2017) (Federal Register of Legislation No. F2017L00010) made under subsection 196B(2) of the VEA is repealed.\n\n1.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 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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that hookworm infection and death from hookworm infection 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 hookworm infection or death from hookworm infection 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(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                               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)          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                               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":"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"},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2017 Statement (section 4) and sets new, specific definitional and evidentiary criteria (explicit species list and extra‑intestinal inclusion, 6‑year exposure window, inability to obtain clinical management as a factor, and explicit inclusion of death via terminal events). From the instrument alone it is clear the operative criteria have been redefined; whether this constitutes an expansion or contraction of coverage relative to the 2017 instrument cannot be determined from this text alone."},"complexity_factors":["Specific species list and distinction between intestinal and extra‑intestinal infections increases definitional specificity (section 7(2)).","Inclusion of death via contribution to a terminal event expands causal scope and requires medical linking of terminal causes (Death provision; Schedule 1 definition of terminal event).","Temporal exposure window: exposures must occur within 6 years before clinical onset (section 9(1)).","Multiple alternative exposure pathways must be considered (contact with contaminated soil/sand, faeces, ingestion, presence in tropical/subtropical or warm damp poor‑sanitation settings) (section 9(1)).","Non‑exposure factor: inability to obtain appropriate clinical management as an independent factor raises evidentiary and proof issues (section 9(2)).","Requirement that any qualifying factor be related to the person's relevant service introduces a legal connection step linking medical facts to service history (section 10(1)).","Interaction with other Statements of Principles requires cross‑reference and application of other SOPs where factors overlap (section 11).","Repeal of the 2017 Statement and replacement by this instrument creates administrative transition considerations for existing claims (section 4).","Reliance on defined statutory terms (VEA, MRCA, relevant service) and external classification codes (ICD‑10‑AM reference) means decision‑makers must handle statutory and clinical classification inputs (sections 5, 7(4))."],"plain_english_summary":"This instrument replaces the 2017 Statement and sets the medical criteria the Repatriation Medical Authority (RMA) will use to decide whether hookworm infection (including specified species, intestinal and extra‑intestinal forms) can be linked to a person’s service for claims under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act. The RMA states this rests on sound medical‑scientific evidence. Claimants must show at least one listed exposure or failure to obtain appropriate clinical management (generally within six years of onset) that is related to their relevant service."},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the same scope as its 2017 predecessor and other Statements of Principles under the VEA. It updates the medical definition of hookworm infection (expanding species coverage and clarifying extraintestinal infection) but does not expand beyond the established purpose of determining service connection for specific diseases. The structure and application provisions remain consistent with the standard template for Repatriation Medical Authority determinations."},"complexity_factors":["Short, single-purpose instrument (approximately 1,500 words)","Only 5 defined terms in the Dictionary (hookworm infection, MRCA, relevant service, terminal event, VEA)","Clear, numbered structure with straightforward conditional logic (section 9 lists alternative factors, only one required)","Minimal cross-referencing — only refers to parent Acts (VEA and MRCA) and one repealed instrument","Single layer of exceptions (subsection 9(2) has a specific limitation for clinical worsening claims)","Medical terminology is explicitly defined or explained in notes (e.g., ICD-10-AM codes, species names)","No nested definitions or recursive references"],"plain_english_summary":"This instrument issues a Statement of Principles allowing veterans and current/former defence members in operational, peacekeeping, hazardous or test service to claim hookworm infection as service-related when medical evidence links exposure during relevant service to their condition. It updates the 2017 guidance, broadens covered hookworm presentations (including cutaneous larva migrans), and stresses a medically significant six-year exposure-to-symptom window and potential worsening from lack of treatment."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-hookworm-infection-reasonable-hypothesis-no-67-of-2025","history":"/api/acts/statement-of-principles-concerning-hookworm-infection-reasonable-hypothesis-no-67-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-hookworm-infection-reasonable-hypothesis-no-67-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-hookworm-infection-reasonable-hypothesis-no-67-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-hookworm-infection-reasonable-hypothesis-no-67-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-hookworm-infection-reasonable-hypothesis-no-67-of-2025/documents"}}