{"id":"F2025L01292","name":"Statement of Principles concerning incisional hernia (Balance of Probabilities) (No. 90 of 2025)","slug":"statement-of-principles-concerning-incisional-hernia-balance-of-probabilities-no-90-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":443010,"registerId":"F2025L01292-fast-fetch-1775957928237","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning incisional hernia (Balance of Probabilities) (No. 90 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\nINCISIONAL HERNIA  (Balance of Probabilities)\n\n(No. 90 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 24 October 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 incisional hernia (Balance of Probabilities) (No. 90 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 24 November 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 incisional hernia (Balance of Probabilities) (No. 74 of 2016) (Federal Register of Legislation No. F2016L01349) made under subsection 196B(3) of the VEA is repealed.\n\n1.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 incisional hernia and death from incisional hernia.\n\n\nMeaning of incisional hernia\n\n1.           For the purposes of this Statement of Principles, incisional hernia:\n  1.           means a protrusion of intra-abdominal tissue through a fascial defect in the abdominal wall at the site of a previous surgical incision; and\n  2.           includes incisional hernia that recurs following surgical repair of an incisional hernia.\n\n\n \n\n1.           While incisional hernia attracts ICD‑10‑AM code K43.0, K43.1 or K43.2, in applying this Statement of Principles the meaning of incisional hernia 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 incisional hernia\n\n1.           For the purposes of this Statement of Principles, incisional hernia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's incisional hernia.\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 incisional hernia and death from incisional 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\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, incisional hernia or death from incisional hernia is connected with the circumstances of a person's relevant service:\n\n1.           having worsening of Marfan syndrome before clinical onset;\n2.           having an incision for a surgical procedure which penetrates the abdominal wall before clinical onset at the incision site;\n\n\nNote: Examples of surgical procedures which can penetrate the abdominal wall include, but are not limited to, laparoscopy, laparotomy, caesarean section, ileostomy, colostomy, prostatectomy, colectomy, and abdominal organ transplantation.\n\n1.           having a superficial infection within 30 days, at the incision site of a surgical procedure which penetrates the abdominal wall, in the 5 years before clinical onset at the incision site;\n\n\n              Note: superficial infection is defined in the Schedule 1 – Dictionary.\n\n1.           having a deep infection within 90 days, at the incision site of a surgical procedure which penetrates the abdominal wall, in the 5 years before clinical onset at the incision site;\n\n\nNote: deep infection is defined in the Schedule 1 – Dictionary.\n\n1.           having wound dehiscence within 30 days, at the incision site of a surgical procedure which penetrates the abdominal wall, before clinical onset at the incision site;\n\n\nNote: wound dehiscence is defined in the Schedule 1 - Dictionary.\n\n1.           taking sirolimus or everolimus for the purpose of transplant immunosuppression, within the 3 years following a surgical procedure which penetrates the abdominal wall, before clinical onset at the incision site;\n2.           taking corticosteroids other than inhaled or topical corticosteroids, for the purpose of immunosuppression, at the time of a surgical procedure which penetrates the abdominal wall, before clinical onset at the incision site;\n3.           taking systemic VEGF or VEGF-receptor inhibitors within the 3 months prior to, or 3 months following a surgical procedure which penetrates the abdominal wall, before clinical onset at the incision site;\n\n\nNote: Examples of VEGF/VEGF-receptor inhibitors include, but are not limited to, bevacizumab, cabozantinib, regorafenib, lenvatinib, axitinib, pazopanib, and nintedanib.\n\n1.           having increased intra-abdominal pressure at the time of, or following a surgical procedure which penetrates the abdominal wall, before clinical onset at the incision site;\n\n\nNote: Examples of conditions or settings which cause increased intra-abdominal pressure include, but are not limited to, ascites, constipation, coughing, heavy lifting, chronic ambulatory peritoneal dialysis, pregnancy, and straining.\n\n1.       having a Body Mass Index (BMI) of 25 or greater at the time of a surgical procedure which penetrates the abdominal wall, before clinical onset at the incision site;\n\n\nNote: Body Mass Index (BMI) is calculated as W/H2 where:\n\n1.         W is the person's weight in kilograms; and\n2.        H is the person's height in metres.\n\n\n1.       having cirrhosis of the liver at the time of a surgical procedure which penetrates the abdominal wall, before clinical onset at the incision site;\n2.       smoking tobacco at the time of (or during healing of) a surgical procedure which penetrates the abdominal wall, before clinical onset at the incision site;\n3.       having severe malnutrition at the time of a surgical procedure which penetrates the abdominal wall, before clinical onset at the incision site;\n\n\n1.       inability to obtain appropriate clinical management for incisional hernia 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(14) applies only to material contribution to, or aggravation of, incisional hernia where the person's incisional hernia 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                               deep infection means an infection involving deep soft tissues of the incision, for example fascial and muscle layers.\n\n                               incisional 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                               superficial infection means an infection involving only the skin and subcutaneous tissue of the incision, other than a stitch abscess in which there is minimal inflammation and discharge confined to the points of suture penetration.\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                               wound dehiscence means a complete or partial disruption of all layers of a surgical wound, including the fascia.\n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a straightforward replacement of a 2016 Statement of Principles concerning the same medical condition (incisional hernia). The scope remains limited to determining liability for this specific condition under veterans' compensation schemes. The structure and purpose align with the original intent of the Repatriation Medical Authority's function under section 196B(3) of the VEA."},"complexity_factors":["Multiple nested time restrictions (e.g., 'within 30 days', 'in the 5 years before', 'within the 3 years following')","Cross-references to other legislation (Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004)","Medical terminology requiring definitions (superficial infection, deep infection, wound dehiscence, terminal event)","Conditional logic requiring specific temporal relationships between surgery, risk factors, and clinical onset","Incorporation of external medical classification system (ICD-10-AM Tenth Edition)","Mathematical formula for BMI calculation embedded in the text"],"plain_english_summary":"This instrument updates the medical rules for when veterans and current or former defence members can claim compensation for incisional hernia or death from it, replacing the 2016 version. It sets a “balance of probabilities” test and identifies 13 medical factors — e.g. prior abdominal surgery, postoperative infection or wound opening, certain medications, and conditions like obesity or cirrhosis — that can link the condition to service.  \n\nIt matters because it governs entitlement decisions and taxpayer-funded compensation."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the Statement of Principles concerning incisional hernia (No. 74 of 2016) (section 4) and replaces it with the current text. The source document does not state whether repeal effects substantive policy changes beyond the new wording; any change in scope must be inferred by comparing the two texts. The current instrument explicitly lists updated factors, timing windows and definitions that will govern VEA s120B and MRCA s339 claims (see sections 5, 7–9 and Schedule 1)."},"complexity_factors":["Legal cross‑references and application: ties to Veterans' Entitlements Act 1986 (s196B(3)) and to claim provisions in VEA s120B and MRCA s339 (see sections 3 and 5) increase procedural complexity.","Replaces prior instrument: repeal of the 2016 Statement creates potential transitional and precedent issues (see section 4).","Medical specificity: numerous clinical concepts and thresholds (incision timing windows, infection depth, BMI cutoff, specific immunosuppressants and VEGF inhibitors) require medical evidence and expert interpretation (see section 9 and Schedule 1 definitions).","'Related to service' link: requirement that listed factors be related to relevant service preserves administrative judgment about causation (see section 10), raising evidentiary and discretion questions.","Interdependence with other Statements: factors that reference other injuries/diseases import external Statements of Principles and create cross‑instrument dependencies (see section 11).","Temporal constraints: multiple different lookback windows and perioperative timing rules (e.g. 30/90 days, 3 months, 3 years, 5 years) demand precise clinical timelines and records.","Definitions and technical terms: reliance on Schedule 1 for definitions (e.g. superficial vs deep infection, wound dehiscence, terminal event) means small definitional differences can affect outcomes."],"plain_english_summary":"This Statement of Principles, made by the Repatriation Medical Authority under subsection 196B(3), defines incisional hernia (including death where relevant), sets specific medical and timing factors which must exist on the balance of probabilities for a claim, and applies to claims under VEA s120B and MRCA s339. It guides decision‑makers assessing veterans’/MRCA compensation claims; claimants must supply clinical evidence of listed factors (for example prior abdominal incision, infection, certain drugs, BMI, smoking, cirrhosis, Marfan syndrome, or inability to obtain care). It replaces the 2016 Statement."},"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-incisional-hernia-balance-of-probabilities-no-90-of-2025","history":"/api/acts/statement-of-principles-concerning-incisional-hernia-balance-of-probabilities-no-90-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-incisional-hernia-balance-of-probabilities-no-90-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-incisional-hernia-balance-of-probabilities-no-90-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-incisional-hernia-balance-of-probabilities-no-90-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-incisional-hernia-balance-of-probabilities-no-90-of-2025/documents"}}