{"id":"F2025L01291","name":"Statement of Principles concerning incisional hernia (Reasonable Hypothesis) (No. 89 of 2025)","slug":"statement-of-principles-concerning-incisional-hernia-reasonable-hypothesis-no-89-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":443011,"registerId":"F2025L01291-fast-fetch-1775957928269","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning incisional hernia (Reasonable Hypothesis) (No. 89 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  (Reasonable Hypothesis)\n\n(No. 89 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    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   \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 (Reasonable Hypothesis) (No. 89 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(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning incisional hernia (Reasonable Hypothesis) (No. 73 of 2016) (Federal Register of Legislation No. F2016L01350) made under subsection 196B(2) of the VEA is repealed.\n\n1.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 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.\n2.           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).\n3.           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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that incisional hernia and death from incisional 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\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 incisional hernia or death from incisional hernia 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.       having chronic obstructive pulmonary disease with chronic coughing at the time of a surgical procedure which penetrates the abdominal wall, at the time of clinical onset at the incision site;\n3.       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;\n4.       having severe malnutrition at the time of a surgical procedure which penetrates the abdominal wall, before clinical onset at the incision site;\n5.       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(15) 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(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                               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)          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                               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":{"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":4,"scope_assessment":{"changed":false,"description":"This is a straightforward reissue/replacement of the 2016 Statement of Principles concerning the same condition. The scope remains tightly focused on establishing medical causation criteria for incisional hernia claims under veterans' compensation legislation. No expansion beyond the original purpose of determining service-relatedness for this specific medical condition."},"complexity_factors":["Moderate cross-referencing between main text and Schedule 1 Dictionary (7 defined terms)","Nested temporal conditions requiring precise timing calculations (e.g., 'within 30 days... in the 5 years before clinical onset')","Multiple medication-specific factors with technical drug names (sirolimus, everolimus, VEGF inhibitors)","Mathematical formula embedded in text (BMI calculation W/H²)","Conditional logic in section 10(2) limiting application of factor 9(15) to pre-existing conditions aggravated by service","Incorporation by reference to other Statements of Principles in section 11","Dual statutory framework application (VEA and MRCA with different service definitions)"],"plain_english_summary":"This instrument sets the medical criteria for when incisional hernia (or death from it) is presumed linked to Australian military service. It replaces the 2016 rules by naming 14 medical factors — any one can create a “reasonable hypothesis” connecting the hernia to service. It affects veterans and current/former defence members claiming under the VEA or MRCA and determines eligibility for compensation."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2016 Statement (section 4) and replaces it with a new Statement that applies to claims under section 120A of the VEA or section 338 of the MRCA (section 5). It redefines the operative medical criteria and lists specific factors and timing windows (section 9; Schedule 1). The text does not describe differences between the old and new provisions, so whether the substantive coverage widened or narrowed relative to the repealed instrument is not specified in this instrument."},"complexity_factors":["Multiple clinical risk factors with precise temporal windows and thresholds (e.g. superficial infection within 30 days, deep infection within 90 days, drug exposure within 3 months or 3 years, BMI ≥25) — requires medical evidence tied to dates (section 9).","Technical medical terminology and diagnostic scope (definition of incisional hernia, inclusion of recurrence, ICD‑10‑AM cross‑reference) — clinical interpretation needed (section 7(2) and 7(3)).","Cross‑reference to other Statements of Principles where a listed factor is itself covered by another Statement — creates dependency on separate instruments (section 11).","Requirement that any listed factor be related to the person's relevant service and special rule for pre‑existing hernia material contribution/aggravation — affects causation analysis and evidentiary burden (section 10).","Legal application limited to claims under specific statutory provisions (section 5) and formal repeal of the prior Statement — procedural/administrative transition issue (sections 4 and 5).","Defined terms in the Schedule (e.g. superficial/deep infection, wound dehiscence, terminal event, relevant service) that determine coverage and interpretation — interpretation risk concentrated in definitions (Schedule 1).","Administrative discretion and threshold language: 'sound medical‑scientific evidence' and 'reasonable hypothesis' require evaluative judgments by decision makers — potential variability in application (section 8 and whole instrument).","Compliance and evidentiary burden on claimants to show timing, treatment, medication use, BMI and service connection — records from surgery, hospital notes and service records will be material (sections 9 and Schedule 1)."],"plain_english_summary":"This instrument sets the medical criteria the Repatriation Medical Authority will use to decide whether an incisional hernia (or death from it) can be reasonably connected to a person's service. It applies to claims under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act, lists specific clinical risk factors and timing windows (e.g. infections, wound dehiscence, medications, BMI, raised intra‑abdominal pressure) that raise a reasonable hypothesis, and replaces the 2016 Statement of Principles."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-incisional-hernia-reasonable-hypothesis-no-89-of-2025","history":"/api/acts/statement-of-principles-concerning-incisional-hernia-reasonable-hypothesis-no-89-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-incisional-hernia-reasonable-hypothesis-no-89-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-incisional-hernia-reasonable-hypothesis-no-89-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-incisional-hernia-reasonable-hypothesis-no-89-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-incisional-hernia-reasonable-hypothesis-no-89-of-2025/documents"}}