{"id":"F2019L01099","name":"Statement of Principles concerning varicocoele (Balance of Probabilities) (No. 80 of 2019)","slug":"statement-of-principles-concerning-varicocoele-balance-of-probabilities-no-80-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440207,"registerId":"F2019L01099-fast-fetch-1775955924023","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning varicocoele (Balance of Probabilities) (No. 80 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\nVARICOCOELE (Balance of Probabilities)\n\n(No. 80 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 23 August 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 varicocoele (Balance of Probabilities) (No. 80 of 2019).\n\n2 Commencement\n\n This instrument commences on 23 September 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 varicocele No. 4 of 2011 (Federal Register of Legislation No. F2010L03251) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 varicocoele and death from varicocoele.\n\nMeaning of varicocoele\n\n(2) For the purposes of this Statement of Principles, varicocoele means an abnormal tortuosity and dilatation of the veins of the pampiniform plexus within the spermatic cord in the scrotum.\n\nNote: Varicocoele usually presents as a scrotal swelling. Varicocoele may also be associated with male infertility.\n\n(3) While varicocoele attracts ICD‑10‑AM code I86.1, in applying this Statement of Principles the meaning of varicocoele 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 varicocoele\n\n(5) For the purposes of this Statement of Principles, varicocoele, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's varicocoele.\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 varicocoele and death from varicocoele 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 varicocoele or death from varicocoele is connected with the circumstances of a person's relevant service:\n\n(1) having an occlusion or stenosis of the testicular venous drainage system before the clinical onset of varicocoele;\n\nNote 1: Blood vessels of the testicular venous drainage system may include, but are not limited to:\n\n(a) inferior vena cava;\n\n(b) internal iliac vein;\n\n(c) left or right renal vein;\n\n(d) lumbar vein;\n\n(e) pampiniform plexus; and\n\n(f) testicular vein.\n\nRare anatomical variants may exist where the testicular vein and its tributaries empty into blood vessels which are not commonly part of the testicular venous drainage system. \n\nNote 2: occlusion or stenosis is defined in the Schedule 1 - Dictionary. \n\n(2) having a nephrectomy within the one year before the clinical onset of the ipsilateral varicocoele;\n\n(3) having an arterio-venous fistula between any of the arteries supplying the testis and a vein of the pampiniform plexus at the time of the clinical onset of varicocoele;\n\nNote: arteries supplying the testis is defined in the Schedule 1 - Dictionary.\n\n(4) having ankylosing spondylitis at the time of the clinical onset of varicocoele;\n\n(5) having an occlusion or stenosis of the testicular venous drainage system before the clinical worsening of varicocoele;\n\nNote 1: Blood vessels of the testicular venous drainage system may include, but are not limited to:\n\n(a) inferior vena cava;\n\n(b) internal iliac vein;\n\n(c) left or right renal vein;\n\n(d) lumbar vein;\n\n(e) pampiniform plexus; and\n\n(f) testicular vein.\n\nRare anatomical variants may exist where the testicular vein and its tributaries empty into blood vessels which are not commonly part of the testicular venous drainage system. \n\nNote 2: occlusion or stenosis is defined in the Schedule 1 - Dictionary. \n\n(6) having a nephrectomy within the one year before the clinical worsening of the ipsilateral varicocoele;\n\n(7) having an arterio-venous fistula between any of the arteries supplying the testis and a vein of the pampiniform plexus at the time of the clinical worsening of varicocoele;\n\nNote: arteries supplying the testis is defined in the Schedule 1 - Dictionary.\n\n(8) having ankylosing spondylitis at the time of the clinical worsening of varicocoele;\n\n(9) inability to obtain appropriate clinical management for varicocoele.\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(5) to 9(9) apply only to material contribution to, or aggravation of, varicocoele where the person's varicocoele 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 arteries supplying the testis means the arteries or their branches that supply the testis.\n\nNote: Arteries supplying the testis include, but are not limited to:\n\n(a) cremasteric artery;\n\n(b) deferential artery;\n\n(c) external pudendal artery; and\n\n(d) testicular artery.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n occlusion or stenosis means complete or partial obstruction to the blood flow of a blood vessel, which may be due to a number of causes including, but not limited to, thrombosis, tumour invasion or external compression of a vein.\n\nNote: External compression of a vein may be due to a disease process or impingement by an anatomical structure, including, but not limited to:\n\n(a) cyst;\n\n(b) left renal vein entrapment syndrome (\"nutcracker\" syndrome);\n\n(c) neoplasm;\n\n(d) pseudocyst;\n\n(e) renal arteriovenous malformation;\n\n(f) retroperitoneal fibrosis; and\n\n(g) retroperitoneal mass.\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 varicocoele — see subsection 7(2).\n\n VEA means the Veterans' Entitlements Act 1986.\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 standard replacement Statement of Principles maintaining the established framework for determining service connection for varicocoele. It updates the 2011 version with current medical evidence but does not expand beyond the original purpose of establishing causation factors for this specific condition under veterans' compensation law."},"complexity_factors":["Moderate cross-referencing between main text and Schedule 1 Dictionary (6 defined terms)","Dual application framework (two different Acts with different service definitions)","Parallel structure with near-identical factors for 'clinical onset' vs 'clinical worsening' creating repetition but also conditional logic","Medical terminology requiring definition (e.g., 'pampiniform plexus', 'ipsilateral', 'arterio-venous fistula')","Nested conditional logic in section 10(2) restricting application of worsening factors to pre-existing conditions","Incorporation by reference of other Statements of Principles (section 11)","Specific temporal limitation ('within the one year') creating precise thresholds"],"plain_english_summary":"This instrument updates the 2011 medical rules for deciding whether varicocoele in current or former Australian Defence Force members is compensable under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. \n\nClaims are assessed on the balance of probabilities: a condition’s clinical onset or a service-linked worsening must be tied to specified medical factors (e.g., venous obstruction, recent nephrectomy, scrotal arteriovenous connection, or ankylosing spondylitis) for compensation to be payable."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2011 Statement of Principles for varicocele (s4) and replaces it with a new set of criteria. The replacement explicitly includes death from varicocoele (s7(5)), separates factors for first clinical onset and for clinical worsening (s9; s10(2)), and adds inability to obtain appropriate clinical management as a potential contributing factor (s9(9)). Those adjustments alter the operative scope and the evidence claimants must present to establish service‑connection."},"complexity_factors":["Technical medical definition and ICD reference (definition of varicocoele; s7(2)-(4)).","Enumerated causal and timing factors (occlusion/stenosis, nephrectomy within one year, arterio‑venous fistula, ankylosing spondylitis, inability to obtain appropriate management; s9(1)-(9)).","Separate treatment of onset versus clinical worsening and requirement that worsening factors apply only where pre‑existing varicocoele existed before service (s10(2); s9(5)-(9)).","Standard of proof grounded in medical‑scientific evidence and balance of probabilities (s8).","Cross‑reference to other Statements of Principles where factors overlap, requiring look‑through to other instruments (s11).","Defined technical terms and examples in the Schedule (occlusion/stenosis, arteries supplying the testis, terminal event, relevant service), which clinicians and decision‑makers must apply (Schedule 1).","Repeal and replacement of the 2011 Statement of Principles may require practitioners to compare versions for transitional or precedent purposes (s4).","Operational complexity lies in assembling and assessing clinical records, imaging or surgical history to meet factor and timing requirements (implied by s9 and Schedule 1)."],"plain_english_summary":"This Statement of Principles sets the medical criteria the Repatriation Medical Authority uses to decide, on the balance of probabilities, whether varicocoele (and death from it) is connected with a person’s service for VEA or MRCA claims. It lists specific clinical and anatomical factors and timing rules that, if present and linked to relevant service, establish service‑connection.\n\nIt affects veterans making compensation or rehabilitation claims, medical assessors who must apply these criteria, and the agencies that pay benefits: claimants must produce medical evidence of the listed factors and timing; decision‑makers apply the criteria to accept or refuse liability."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-varicocoele-balance-of-probabilities-no-80-of-2019","history":"/api/acts/statement-of-principles-concerning-varicocoele-balance-of-probabilities-no-80-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-varicocoele-balance-of-probabilities-no-80-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-varicocoele-balance-of-probabilities-no-80-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-varicocoele-balance-of-probabilities-no-80-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-varicocoele-balance-of-probabilities-no-80-of-2019/documents"}}