{"id":"F2024L01703","name":"Statement of Principles concerning peritoneal adhesions (Reasonable Hypothesis) (No. 9 of 2025)","slug":"statement-of-principles-concerning-peritoneal-adhesions-reasonable-hypothesis-no-9-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442683,"registerId":"F2024L01703-fast-fetch-1775957633715","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning peritoneal adhesions (Reasonable Hypothesis) (No. 9 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\nPERITONEAL ADHESIONS  (Reasonable Hypothesis)\n\n(No. 9 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    17 December 2024.\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 peritoneal adhesions (Reasonable Hypothesis) (No. 9 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 28 January 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 peritoneal adhesions (Reasonable Hypothesis) (No. 3 of 2016) (Federal Register of Legislation No. F2016L00004) made under subsections 196B(2) and (8)  of the VEA is repealed.\n\n1.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 peritoneal adhesions and death from peritoneal adhesions.\n\n\nMeaning of peritoneal adhesions\n\n1.           For the purposes of this Statement of Principles, peritoneal adhesions:\n  1.           means acquired permanent abnormal fibrous connections between abdominal organs or between abdominal organs and the parietal peritoneum, resulting from an abnormal inflammatory reaction of the peritoneum; and\n  2.           includes encapsulating peritoneal sclerosis (sclerosing encapsulating peritonitis); and\n  3.           excludes congenital peritoneal adhesions.\n\n\nNote: Peritoneal adhesions can be asymptomatic, or can cause bowel obstructions, dyspareunia, female infertility, obstetric complications, abdominal pain, and difficulty performing subsequent abdominal surgery.\n\n1.           While peritoneal adhesions attracts ICD‑10‑AM codes K66.0, N73.6, and N99.4, in applying this Statement of Principles the meaning of peritoneal adhesions 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 peritoneal adhesions\n\n1.           For the purposes of this Statement of Principles, peritoneal adhesions, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's peritoneal adhesions.\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 peritoneal adhesions and death from peritoneal adhesions 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 peritoneal adhesions or death from peritoneal adhesions with the circumstances of a person's relevant service:\n\n1.           having peritonitis at least 3 days before clinical onset;\n2.           having one of the following diseases at least 3 days before clinical onset:\n  1.           appendicitis;\n  2.           cholecystitis;\n  3.           diverticulitis;\n  4.           endometriosis;\n  5.           inflammatory bowel disease;\n  6.            pancreatitis; \n  7.           pelvic inflammatory disease.\n3.           having intra-abdominal or pelvic surgery at least 3 days before clinical onset;\n4.           having penetrating trauma to the abdomen that enters the peritoneal cavity at least 3 days before clinical onset;\n5.           undergoing a course of ablative radiotherapy for cancer, where the abdominopelvic region was in the field of radiation, at least 3 days before clinical onset;\n6.           having a bacterial, fungal or Echinococcus granulosus infection involving the peritoneal cavity at least 3 days before clinical onset;\n7.           having a perforation of the hollow viscus into the peritoneal cavity at least 3 days before clinical onset;\n\n\nNote: A perforated hollow viscus could include a perforated stomach, gallbladder, intestine, appendix, renal pelvis, ureter, bladder, or uterus.\n\n1.           undergoing peritoneal dialysis for at least 6 months duration before clinical onset;\n2.           undergoing intraperitoneal chemotherapy with cisplatin, oxaliplatin, carboplatin, 5-fluorouracil, mitoxantrone (mitozantrone), or mitomycin C at least 3 days before clinical onset;\n3.       having a primary or secondary malignant neoplasm involving the peritoneum at least 3 days before clinical onset;\n4.       having an ovarian dermoid cyst rupturing into the peritoneum at least 3 days before clinical onset;\n5.       having a ventriculoperitoneal shunt at least 3 days before clinical onset;\n6.       having a peritoneovenous shunt at least 3 days before the clinical onset of encapsulating peritoneal sclerosis;\n7.       having hernia mesh inserted in the abdomen at the site of the subsequent peritoneal adhesions at least 3 days before clinical onset;\n8.       having a retained surgical sponge at least 3 days before clinical onset;\n9.       taking practolol for at least 1 year before clinical onset;\n10.       having peritoneal sarcoidosis at the time of clinical onset.\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.\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                                MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n                               peritoneal adhesions—see subsection 7(2).\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":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the standard scope of Repatriation Medical Authority Statements of Principles. It replaces the 2016 version (No. 3 of 2016) with updated medical criteria but does not expand beyond the traditional purpose of establishing service connection for specific medical conditions. The structure and approach remain consistent with the long-established framework under section 196B of the Veterans' Entitlements Act 1986."},"complexity_factors":["Moderate length (approximately 1,500 words) with clear section numbering","17 distinct causal factors with varying temporal requirements (mostly 'at least 3 days before clinical onset', but with exceptions: 6 months for peritoneal dialysis, 1 year for practolol, and 'at time of' for sarcoidosis)","Cross-referencing mechanism in section 11 that incorporates other Statements of Principles by reference","Technical medical terminology throughout (peritoneum, viscus, neoplasm, etc.) requiring some medical knowledge","Specific drug names and medical procedures listed that require precise identification","Dual legislative framework application (VEA and MRCA) with defined service categories","ICD-10-AM coding reference with specific edition citation (Tenth Edition, 1 July 2017)"],"plain_english_summary":"This instrument tells the Department of Veterans’ Affairs when peritoneal adhesions (including encapsulating peritoneal sclerosis) must be treated as service-related for claims under the VEA and MRCA. It lists 17 medical factors — e.g., abdominal surgery, infections, trauma, radiation, dialysis, certain drugs or retained surgical items — that create a reasonable hypothesis of service connection if linked to service.\n\nIt replaces the 2016 version and includes timing rules (e.g., factor before symptoms; dialysis and some drugs require longer exposure)."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2016 Statement of Principles (s4) and substitutes a new Statement that applies to claims under VEA s120A and MRCA s338 (s5). It restates the statutory medical definition, specifies a roster of causal factors with temporal thresholds (s7(2); s9) and retains the requirement that any factor be connected to the person’s relevant service (s10(1)), thereby replacing the prior instrument’s scope with the provisions now set out."},"complexity_factors":["Medical definition and exclusion of congenital adhesions (s7(2))","Detailed list of triggering clinical events, procedures and exposures with different temporal thresholds (s9: most factors ≥3 days, peritoneal dialysis ≥6 months, practolol ≥1 year)","Inclusion of death via contribution to a terminal event and definition of 'terminal event' (s7(4); Schedule 1)","Interplay with other Statements of Principles where a factor refers to a disease covered elsewhere (s11)","Requirement that any listed factor be related to the person’s relevant service (s10(1))","Repeal and replacement of the 2016 Statement (s4) requiring interpretation against a new instrument","Application limited to claims under specific provisions of the VEA and MRCA (s5)","Reference to ICD‑10‑AM codes while giving an independent statutory meaning to the condition (s7(3))","Broad range of medical, surgical and device-related causes increasing evidentiary variety (s9)"],"plain_english_summary":"This Statement of Principles (commencing 28 January 2025) sets the medical criteria the Repatriation Medical Authority uses to decide when peritoneal adhesions (and death from them) can be linked to a veteran’s or service member’s relevant service. It replaces the earlier 2016 Statement.  \n\nIt defines peritoneal adhesions, lists specific clinical events, procedures and exposures (with minimum time thresholds) that can raise a “reasonable hypothesis” of service connection, and requires those factors to be related to the person’s relevant service — rules that directly affect entitlement assessments under the VEA and MRCA."},"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-peritoneal-adhesions-reasonable-hypothesis-no-9-of-2025","history":"/api/acts/statement-of-principles-concerning-peritoneal-adhesions-reasonable-hypothesis-no-9-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-peritoneal-adhesions-reasonable-hypothesis-no-9-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-peritoneal-adhesions-reasonable-hypothesis-no-9-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-peritoneal-adhesions-reasonable-hypothesis-no-9-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-peritoneal-adhesions-reasonable-hypothesis-no-9-of-2025/documents"}}