{"id":"F2019L00249","name":"Statement of Principles concerning pilonidal sinus (Balance of Probabilities) (No. 28 of 2019)","slug":"statement-of-principles-concerning-pilonidal-sinus-balance-of-probabilities-no-28-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439965,"registerId":"F2019L00249-fast-fetch-1775955780915","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning pilonidal sinus (Balance of Probabilities) (No. 28 of 2019)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nPILONIDAL SINUS (Balance of Probabilities)\n\n(No. 28 of 2019)\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 1 March 2019\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
|\n| --- |\n| 
Professor Nicholas Saunders AO
Chairperson
|\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\n1 Name\n\nThis is the Statement of Principles concerning pilonidal sinus (Balance of Probabilities) (No. 28 of 2019).\n\n2 Commencement\n\n This instrument commences on 25 March 2019.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning pilonidal sinus No. 72 of 2010 (Federal Register of Legislation No. F2010L02311) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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\n6 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about pilonidal sinus and death from pilonidal sinus.\n\nMeaning of pilonidal sinus\n\n(2) For the purposes of this Statement of Principles, pilonidal sinus:\n\n(a) means an inflammatory tissue reaction of the skin to an embedded hair which is manifested by the development of a sinus or fistula; and\n\n(b) includes pilonidal cyst and pilonidal fistula; and\n\n(c) excludes ingrown hair.\n\nNote: Pilonidal sinus principally occurs in the sacrococcygeal region, but can also occur in the interdigital webs of the hands and in other regions of the body.\n\n(3) While pilonidal sinus attracts ICD‑10‑AM code L05, in applying this Statement of Principles the meaning of pilonidal sinus is that given in subsection (2).\n\n(4) 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 pilonidal sinus\n\n(5) For the purposes of this Statement of Principles, pilonidal sinus, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's pilonidal sinus.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n8 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 pilonidal sinus and death from pilonidal sinus 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\n9 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, pilonidal sinus or death from pilonidal sinus is connected with the circumstances of a person's relevant service:\n\n(1) for pilonidal sinus of the hand or foot only:\n\n(a) working as a hairdresser or barber within the six months before the clinical onset of pilonidal sinus; or\n\n(b) having cutaneous exposure to animal hair within the six months before the clinical onset of pilonidal sinus;\n\nNote: having cutaneous exposure to animal hair is defined in the Schedule 1 - Dictionary. \n\n(2) for pilonidal sinus of the sacrococcygeal region only:\n\n(a) driving or being a seated passenger in a motorised vehicle for an average of at least 20 hours per week for a period of at least three months, within the six months before the clinical onset of pilonidal sinus; or\n\n(b) being overweight or obese within the six months before the clinical onset of pilonidal sinus;\n\nNote: being overweight or obese is defined in the Schedule 1 - Dictionary. \n\n(3) for pilonidal sinus of the sacrococcygeal and umbilical regions only, inability to shower or bathe more than two times per week for a period of at least four weeks, within the six months before the clinical onset of pilonidal sinus;\n\n(4) for pilonidal sinus of the hand or foot only:\n\n(a) working as a hairdresser or barber within the six months before the clinical worsening of pilonidal sinus; or\n\n(b) having cutaneous exposure to animal hair within the six months before the clinical worsening of pilonidal sinus;\n\nNote: having cutaneous exposure to animal hair is defined in the Schedule 1 - Dictionary. \n\n(5) for pilonidal sinus of the sacrococcygeal region only:\n\n(a) driving or being a seated passenger in a motorised vehicle for an average of at least 20 hours per week for a period of at least three months, within the six months before the clinical worsening of pilonidal sinus; or\n\n(b) being overweight or obese within the six months before the clinical worsening of pilonidal sinus;\n\nNote: being overweight or obese is defined in the Schedule 1 - Dictionary. \n\n(6) for pilonidal sinus of the sacrococcygeal and umbilical regions only, inability to shower or bathe more than two times per week for a period of at least four weeks, within the six months before the clinical worsening of pilonidal sinus;\n\n(7) inability to obtain appropriate clinical management for pilonidal sinus.\n\n10 Relationship to service\n\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\n(2) The factors set out in subsections 9(4) to 9(7) apply only to material contribution to, or aggravation of, pilonidal sinus where the person's pilonidal sinus was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1) if a factor referred to in section 9 applies in relation to a person; and\n\n(2) 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\n \n\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n being overweight or obese means having a Body Mass Index (BMI) of 25 or greater.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\n BMI means W/H2 where:\n\nW is the person's weight in kilograms; and\n\nH is the person's height in metres.\n\n having cutaneous exposure to animal hair means milking, shearing, grooming, clipping or slaughtering animals.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n pilonidal sinus—see subsection 7(2).\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 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 is a standard replacement Statement of Principles under the Veterans' Entitlements Act framework. It maintains the same narrow, technical purpose as its 2010 predecessor: establishing specific causal factors for a single medical condition in veterans compensation claims. No scope creep is evident."},"complexity_factors":["Multiple location-specific factor sets (hand/foot vs sacrococcygeal vs sacrococcygeal+umbilical) creating conditional branches","Temporal requirements ('within the six months before') that must be precisely calculated","Dual trigger points — factors apply to both 'clinical onset' and 'clinical worsening' with slightly different rules","Cross-referencing between the main sections and Schedule 1 definitions (BMI calculation, animal hair exposure, terminal event)","Nested definitions requiring mathematical calculation (BMI = W/H²)","Interaction clause in section 11 requiring reference to other Statements of Principles if factors overlap","Distinction between conditions arising 'before or during' service vs 'out of' service in section 10(2)"],"plain_english_summary":"This instrument updates the medical criteria used to decide compensation for pilonidal sinus under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. It affects current and former ADF members and DVA decision-makers: to succeed, a claimant must show at least one specified service‑related risk factor existed in the six months before onset or worsening. It replaces the 2010 guidance and serves as the legal gatekeeper for these claims."},"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":3,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals Statement of Principles No.72 of 2010 and replaces it with the current criteria (s.4). The text does not itself state whether eligibility criteria have been broadened or narrowed; assessing substantive scope change requires side‑by‑side comparison with the repealed instrument."},"complexity_factors":["Multiple technical definitions concentrated in Schedule 1 (e.g. 'being overweight or obese' = BMI ≥ 25; 'having cutaneous exposure to animal hair') — see Schedule 1.","Body‑region specific criteria and separate tests for onset versus worsening (s.9(1)–(6)) increase conditional complexity.","Short, precise temporal windows and exposure durations (e.g. within six months; average ≥20 hours/week for ≥3 months; inability to shower >2×/week for ≥4 weeks) require concrete factual proof (s.9).","Requirement that any listed factor be 'related to the relevant service' places evidential linking burden on claimants and adjudicators (s.10(1)).","Open‑ended factor of 'inability to obtain appropriate clinical management' creates discretion and evidentiary judgment calls (s.9(7)).","Interaction with other Statements of Principles means cross‑reference and application of external criteria where factors overlap (s.11).","Inclusion of 'death from pilonidal sinus' tied to defined 'terminal events' introduces causation analysis in mortality cases (s.7(5); Schedule 1).","Instrument repeals the prior 2010 Statement (s.4), so determining net scope change may require textual comparison with the repealed instrument."],"plain_english_summary":"This Statement of Principles (Repatriation Medical Authority) sets the medical criteria used to decide whether pilonidal sinus — and death from it — is connected to a veteran’s or member’s relevant service for claims under the VEA or MRCA. It lists specific, time‑limited exposure and risk factors (by body region) — e.g. hairdressing or animal hair exposure for hands/feet; prolonged seated driving, BMI ≥25, or poor hygiene for sacrococcygeal/umbilical regions — and requires those factors to be related to the person’s relevant service to establish connection."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-pilonidal-sinus-balance-of-probabilities-no-28-of-2019","history":"/api/acts/statement-of-principles-concerning-pilonidal-sinus-balance-of-probabilities-no-28-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-pilonidal-sinus-balance-of-probabilities-no-28-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-pilonidal-sinus-balance-of-probabilities-no-28-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-pilonidal-sinus-balance-of-probabilities-no-28-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-pilonidal-sinus-balance-of-probabilities-no-28-of-2019/documents"}}