{"id":"F2021L00497","name":"Statement of Principles concerning inguinal hernia (Balance of Probabilities) (No. 48 of 2021)","slug":"statement-of-principles-concerning-inguinal-hernia-balance-of-probabilities-no-48-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":101723,"registerId":"commonwealth-F2021L00497-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning inguinal hernia (Balance of Probabilities) (No. 48 of 2021)","content":"![Commonwealth Coat of Arms](image.001.png)\n\nStatement of Principles concerning inguinal hernia (Balance of Probabilities) (No. 48 of 2021)\n\nmade under subsection 196B(3) of the\n\nVeterans' Entitlements Act 1986\n\nCompilation No. 1\n\nCompilation date: 22 September 2025\n\nIncludes amendments: Amendment Statement of Principles concerning inguinal hernia (Balance of Probabilities) (No. 80 of 2025) (F2025L01077)\n\nAbout this compilation\n\nThis compilation\n\nThis is a compilation of the Statement of Principles concerning inguinal hernia (Balance of Probabilities) (No. 48 of 2021) that shows the text of the law as amended and in force on 22 September 2025.\n\nThe notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.\n\nUncommenced amendments\n\nThe effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the Register for the compiled law.\n\nApplication, saving and transitional provisions for provisions and amendments\n\nIf the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.\n\nModifications\n\nIf the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the Register for the compiled law.\n\nSelf‑repealing provisions\n\nIf a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.\n\nContents\n\n1 Name\n\n3 Authority\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\nEndnotes\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\n  \n\n1.  Name\n\nThis is the Statement of Principles concerning inguinal hernia (Balance of Probabilities) (No. 48 of 2021).\n\n1.  Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.  Application\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\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 inguinal hernia and death from inguinal hernia.\n\nMeaning of inguinal hernia\n\n1.  For the purposes of this Statement of Principles, inguinal hernia means:\n    1.  a protrusion of intra-abdominal tissue through the abdominal wall either:\n        1.  through the inguinal canal; or\n        2.  through a weakness in the posterior wall of the inguinal canal; and\n    2.  includes direct and indirect inguinal hernia; and\n    3.  excludes femoral hernia.\n2.  While inguinal hernia attracts ICD‑10‑AM code K40, in applying this Statement of Principles the meaning of inguinal 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\nDeath from inguinal hernia\n\n1.  For the purposes of this Statement of Principles, inguinal hernia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's inguinal hernia.\n\n> Note: terminal event is defined in the Schedule 1 - Dictionary.\n\n1.  Basis for determining the factors\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that inguinal hernia and death from inguinal hernia can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\n> Note: MRCA, relevant service and VEA are defined in the Schedule 1 - Dictionary.\n\n1.  Factors that must exist\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, inguinal hernia or death from inguinal hernia is connected with the circumstances of a person's relevant service:\n\n1.  having acute elevation of pressure within the abdominal cavity due to any one of the following:\n    1.  anti-G straining manoeuvre;\n    2.  lifting heavy weights;\n    3.  physical trauma to the abdomen involving a direct blow to the abdomen;\n    4.  pneumoperitoneum induced for laparoscopic surgery;\n    5.  significant coughing;\n    6.  significant sneezing;\n    7.  straining at micturition due to bladder outlet or urethral obstruction; or\n    8.  straining at stool due to constipation or diarrhoea;\n\nwithin the 30 days before the clinical onset of inguinal hernia;\n\nNote: clinical onset is defined in the Schedule 1 – Dictionary.\n\n1.  having chronic elevation of pressure within the abdominal cavity due to any one of the following:\n    1.  ascites;\n    2.  chronic ambulatory or automatic peritoneal dialysis;\n    3.  extensive intra-abdominal neoplastic disease or mass; or\n    4.  pregnancy;\n\nat the time of the clinical onset of inguinal hernia;\n\n> Note: Chronic elevation of pressure may be intermittent or continuous.\n\n1.  undergoing radical retropubic prostatectomy, laparoscopic radical prostatectomy or robot-assisted laparoscopic radical prostatectomy within the five years before the clinical onset of inguinal hernia;\n2.  having chronic onchocerciasis in the presence of a hanging groin at the time of the clinical onset of inguinal hernia;\n\n> Note 1: Onchocerciasis is a parasitic disease caused by the filarial worm Onchocerca volvulus that occurs in sub-Saharan African countries, and in some areas of South America and Yemen. Symptoms include severe itching, disfiguring skin conditions and visual impairment.\n\n> Note 2: hanging groin is defined in the Schedule 1 - Dictionary.\n\n1.  for uretero-inguinal hernia only, having a kidney transplant before the clinical onset of uretero-inguinal hernia;\n2.  having acute elevation of pressure within the abdominal cavity due to any one of the following:\n    1.  anti-G straining manoeuvre;\n    2.  lifting heavy weights;\n    3.  physical trauma to the abdomen involving a direct blow to the abdomen;\n    4.  pneumoperitoneum induced for laparoscopic surgery;\n    5.  significant coughing;\n    6.  significant sneezing;\n    7.  straining at micturition due to bladder outlet or urethral obstruction; or\n    8.  straining at stool due to constipation or diarrhoea;\n\nwithin the 30 days before the clinical worsening of inguinal hernia;\n\n1.  having chronic elevation of pressure within the abdominal cavity due to any one of the following:\n    1.  ascites;\n    2.  chronic ambulatory or automatic peritoneal dialysis;\n    3.  extensive intra-abdominal neoplastic disease or mass; or\n    4.  pregnancy;\n\nat the time of the clinical worsening of inguinal hernia;\n\n> Note: Chronic elevation of pressure may be intermittent or continuous.\n\n1.  undergoing radical retropubic prostatectomy, laparoscopic radical prostatectomy or robot-assisted laparoscopic radical prostatectomy within the five years before the clinical worsening of inguinal hernia;\n2.  having chronic onchocerciasis in the presence of a hanging groin at the time of the clinical worsening of inguinal hernia;\n\n> Note 1: Onchocerciasis is a parasitic disease caused by the filarial worm Onchocerca volvulus that occurs in sub-Saharan African countries, and in some areas of South America and Yemen. Symptoms include severe itching, disfiguring skin conditions and visual impairment.\n\n> Note 2: hanging groin is defined in the Schedule 1 - Dictionary.\n\n1.  for perforated inguinal hernia only, having a colonoscopy where the colonoscope enters the inguinal hernia within the 24 hours before the perforation of the inguinal hernia;\n2.  inability to obtain appropriate clinical management for inguinal hernia.\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 factors set out in subsections 9(6) to 9(11) apply only to material contribution to, or aggravation of, inguinal hernia where the person's inguinal 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\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\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\nSchedule 1 \\- Dictionary\n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\nclinical onset means the point backwards in time from the date of presentation to a registered medical practitioner first confirming the presence of inguinal hernia, to the date at which the signs and/or symptoms of the inguinal hernia were persistently present, as assessed by a registered medical practitioner.\n\nhanging groin means a sac of atrophic skin containing enlarged, sclerosed inguinal or femoral lymph glands.\n\ninguinal hernia—see subsection 7(2).\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\nrelevant 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\n> Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\nterminal 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\nVEA means the Veterans' Entitlements Act 1986.\n\n> Note: Endnotes\n\n> Note: Endnote 1—About the endnotes\n\nThe endnotes provide information about this compilation and the compiled law.\n\nThe following endnotes are included in every compilation:\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\nAbbreviation key—Endnote 2\n\nThe abbreviation key sets out abbreviations that may be used in the endnotes.\n\nLegislation history and amendment history—Endnotes 3 and 4\n\nAmending laws are annotated in the legislation history and amendment history.\n\nThe legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.\n\nThe amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.\n\nMisdescribed amendments\n\nA misdescribed amendment is an amendment that does not accurately describe how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.\n\nIf a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and “(md not incorp)” is added to the amendment history.\n\n> Note: Endnote 2—Abbreviation key\n\n| ad = added or inserted                         | orig = original                     |\n| ---------------------------------------------- | ----------------------------------- |\n| am = amended                                   | par = paragraph(s)/subparagraph(s)  |\n| amdt = amendment                               | /sub‑subparagraph(s)                |\n| c = clause(s)                                  | pres = present                      |\n| C[x] = Compilation No. x                       | prev = previous                     |\n| Ch = Chapter(s)                                | (prev…) = previously                |\n| def = definition(s)                            | Pt = Part(s)                        |\n| Dict = Dictionary                              | r = regulation(s)/rule(s)           |\n| disallowed = disallowed by Parliament          | reloc = relocated                   |\n| Div = Division(s)                              | renum = renumbered                  |\n| exp = expires/expired or ceases/ceased to have | rep = repealed                      |\n| effect                                         | rs = repealed and substituted       |\n| F = Federal Register of Legislation            | s = section(s)/subsection(s)        |\n| gaz = gazette                                  | Sch = Schedule(s)                   |\n| LA = Legislation Act 2003                      | Sdiv = Subdivision(s)               |\n| LIA = Legislative Instruments Act 2003         | SLI = Select Legislative Instrument |\n| (md not incorp) = misdescribed amendment       | SR = Statutory Rules                |\n| cannot be given effect                         | Sub‑Ch = Sub‑Chapter(s)             |\n| mod = modified/modification                    | SubPt = Subpart(s)                  |\n| No. = Number(s)                                | underlining = whole or part not     |\n| o = order(s)                                   | commenced or to be commenced        |\n| Ord = Ordinance                                |                                     |\n\n> Note: Endnote 3—Legislation history\n\n| Name                                                                                                     | Registration                 | Commencement      | Application, saving and transitional provisions |\n| -------------------------------------------------------------------------------------------------------- | ---------------------------- | ----------------- | ----------------------------------------------- |\n| Statement of Principles concerning inguinal hernia (Balance of Probabilities) (No. 48 of 2021)           | 27 April 2021F2021L00497     | 24 May 2021       |                                                 |\n| Amendment Statement of Principles concerning inguinal hernia (Balance of Probabilities) (No. 80 of 2025) | 10 September 2025F2025L01077 | 22 September 2025 |                                                 |\n\n> Note: Endnote 4—Amendment history\n\n| Provision affected                              | How affected      |\n| ----------------------------------------------- | ----------------- |\n| Section 2……………….                                | rep LA s 48D      |\n| Section 4……………….                                | rep LA s 48C      |\n| Subsection 9(1)………..                            | rs No. 79 of 2025 |\n| Schedule 1 – Dictionary – clinical onset……...…. | ad No. 79 of 2025 |","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":"The instrument was amended after initial registration. Endnote 4 records changes to subsection 9(1) and addition/amendment to the Schedule 1 clinical onset definition (amendment No. 79/80 of 2025). Those amendments alter the list and timing of qualifying factors and the key evidentiary concept of 'clinical onset', so they change the practical scope of cases that meet the Statement's tests (see Endnote 4 and Endnote 3 for amendment dates)."},"complexity_factors":["Application to claims under VEA and MRCA narrows who is affected (s3).","The Repatriation Medical Authority establishes the medical basis using available evidence (s8) — administrative discretion in setting criteria.","Claimants must show at least one enumerated factor from section 9 (s9) and link it to relevant service (s10), creating evidentiary burden on veterans/claimants.","Temporal windows and varying time-limits increase factual complexity: e.g. 30 days before clinical onset for acute pressure events (s9(1)); five years for certain prostatectomies (s9(3)); 24 hours for colonoscopy-related perforation (s9(11)).","Technical medical definitions and diagnostics are required: clinical onset and hanging groin defined in Schedule 1 - Dictionary; ICD reference for code mapping (s7(2)–(3); Schedule 1).","Cross-references to other Statements of Principles mean overlapping conditions are governed by their own SOPs (s11), requiring cross-document analysis.","Some factors apply only to material contribution or aggravation where hernia pre‑existed service, adding legal nuance to causation (s10(2) and s9(6)–(11)).","Inability-to-treat factor and rare specific factors (e.g. uretero-inguinal hernia after kidney transplant) expand non-standard factual inquiries (s9(12) and s9(5)).","Compilation and amendment history (Endnotes) record recent changes to subsection 9(1) and the clinical onset definition which can affect scope and application (Endnote 4)."],"plain_english_summary":"This Statement of Principles sets the medical criteria used to decide whether an inguinal hernia (or death from it) is connected to a veteran's or service member's relevant service for claims under the VEA or MRCA. It defines inguinal hernia and lists specific events, conditions and time limits (for example recent acute pressure events or surgeries) that, if proved and linked to relevant service, establish connection on the balance of probabilities.\n\nDecisions turn on proving one of the listed factors exists and is related to the person's relevant service; the Repatriation Medical Authority framed the list from medical evidence."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"The legislation maintains its original narrow scope as a medical-determination instrument for a specific condition (inguinal hernia) under the veterans' compensation scheme. The 2025 amendment appears to be a technical update (repealing sections 2 and 4, and updating subsection 9(1) and the dictionary definition of 'clinical onset') rather than an expansion of substantive coverage. The instrument continues to serve its original purpose: establishing the causal link between service and this specific medical condition."},"complexity_factors":["Moderate cross-referencing between the main text and Schedule 1 (Dictionary) for defined terms like 'clinical onset', 'hanging groin', and 'terminal event'","Dual structure covering both 'clinical onset' (first appearance of disease) and 'clinical worsening' (aggravation) with nearly identical factor lists, creating repetition","Specific temporal requirements (30 days for acute pressure, 5 years for prostate surgery, 24 hours for colonoscopy perforation) that must be precisely tracked","Nested conditional logic in section 10 — factors 9(6) through 9(11) only apply if the hernia existed before or during service but didn't arise from service (aggravation vs. causation distinction)","Incorporation by reference of external medical classification systems (ICD-10-AM Tenth Edition) for disease coding","Interaction clause in section 11 requiring cross-checking with other Statements of Principles when factors reference other diseases","Specialised medical terminology requiring lay explanation (e.g., 'pneumoperitoneum', 'onchocerciasis', 'radical retropubic prostatectomy')"],"plain_english_summary":"This Statement of Principles sets the medical test for whether an inguinal hernia is linked to military service, affecting veterans and defence personnel claiming under the VEA or MRCA and the DVA decision-makers who assess those claims. It requires a “balance of probabilities” showing at least one specified service‑related factor tied to onset or worsening of the hernia. It’s the gatekeeper for compensation and related care."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-inguinal-hernia-balance-of-probabilities-no-48-of-2021","history":"/api/acts/statement-of-principles-concerning-inguinal-hernia-balance-of-probabilities-no-48-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-inguinal-hernia-balance-of-probabilities-no-48-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-inguinal-hernia-balance-of-probabilities-no-48-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-inguinal-hernia-balance-of-probabilities-no-48-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-inguinal-hernia-balance-of-probabilities-no-48-of-2021/documents"}}