{"id":"F2019L01092","name":"Statement of Principles concerning varicocoele (Reasonable Hypothesis) (No. 79 of 2019)","slug":"statement-of-principles-concerning-varicocoele-reasonable-hypothesis-no-79-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440198,"registerId":"F2019L01092-fast-fetch-1775955919713","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning varicocoele (Reasonable Hypothesis) (No. 79 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 (Reasonable Hypothesis)\n\n(No. 79 of 2019)\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 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 (Reasonable Hypothesis) (No. 79 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning varicocele No. 3 of 2011 (Federal Register of Legislation No. F2010L03250) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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\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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that varicocoele and death from varicocoele 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\n9 Factors that must exist\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 varicocoele or death from varicocoele 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 Behcet disease at the time of the clinical onset of varicocoele;\n\n(6) 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(7) having a nephrectomy within the one year before the clinical worsening of the ipsilateral varicocoele;\n\n(8) 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(9) having ankylosing spondylitis at the time of the clinical worsening of varicocoele;\n\n(10) having Behcet disease at the time of the clinical worsening of varicocoele;\n\n(11) undertaking physical activity at a minimum intensity of six METs, for at least six hours per week for at least the four weeks before the clinical worsening of varicocoele;\n\nNote: MET is defined in the Schedule 1 - Dictionary.\n\n(12) for rupture of varicocoele only:\n\n(a) having sexual intercourse at the time of the clinical worsening of varicocoele; or\n\n(b) having increased intra-abdominal pressure as specified, which has resulted in a scrotal or spermatic cord haematoma, within the seven days before the clinical worsening of varicocoele;\n\nNote: increased intra-abdominal pressure as specified is defined in the Schedule 1 - Dictionary.\n\n(13) 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(6) to 9(13) 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(2) 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\narteries 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 increased intra-abdominal pressure as specified means acute elevation of pressure within the lower abdominal region due to various activities, including, but not limited to:\n\n(a) lifting heavy weights;\n\n(b) physical trauma to the lower abdomen involving a direct blow to the lower abdominal region;\n\n(c) straining at stool due to constipation; and\n\n(d) using manual tools requiring excessive force such as pulling forcefully on a large spanner or socket wrench.\n\nMET means a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute, or 1.0 kcal/kg of body weight per hour, or resting metabolic rate.\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\nocclusion 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\nrelevant 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 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\nvaricocoele — see subsection 7(2).\n\nVEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","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":3,"scope_assessment":{"changed":false,"description":"This instrument repeals and replaces the earlier Statement of Principles (section 4) but remains narrowly focused on varicocoele and death from varicocoele. The replacement refines definitions and enumerates specific factors (e.g. nephrectomy timing, METs threshold, rupture conditions, and inability to obtain care) that can raise the statutory \"reasonable hypothesis\". Those refinements clarify and update the medical criteria rather than expanding the legislative purpose beyond the original objective of setting medical guidance for entitlements under the VEA and MRCA."},"complexity_factors":["Single subject, short instrument (11 sections plus a Dictionary)","13 primary causal factors listed in section 9, some with subparts (e.g. 9(12)(a) and (b))","Temporal distinctions between 'clinical onset' and 'clinical worsening' create conditional logic (sections 9 and 10(2))","A modest dictionary in Schedule 1 with about 10 defined terms (e.g. occlusion or stenosis, MET, arteries supplying the testis, relevant service, terminal event)","Cross-reference to other Statements of Principles where overlap exists (section 11)","Reference to external classification (ICD‑10‑AM) but overridden by the instrument's in‑text definition (section 7(3)–(4))"],"plain_english_summary":"**What this instrument does (mechanics)\n\n- Replaces the previous Statement of Principles about varicocoele and sets the medical test that decision‑makers must use when deciding whether a veteran’s varicocoele (or death from it) can be connected to their military service (see sections 3, 4 and 5).\n- Defines what is meant by \"varicocoele\" for the purposes of entitlement decisions (section 7(2)) and confirms death caused or contributed to by varicocoele is included (section 7(5)).\n- Lists specific medical or related factors which, if present, are sufficient to raise a \"reasonable hypothesis\" that the varicocoele is related to relevant service. At least one of the listed factors must exist (section 9).\n- Explains how the factors must relate to the service (section 10) and how this Statement interacts with other Statements of Principles that may cover related injuries or diseases (section 11).\n\nWho is affected\n\n- Veterans, members of Peacekeeping Forces, and members of the Australian Defence Forces whose compensation or rehabilitation claim falls under the Veterans' Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA) (section 5; Schedule 1 definition of \"relevant service\").\n- Clinicians and medical assessors who must document whether any of the listed factors existed and whether they relate to the person’s service.\n- Decision makers who administer entitlements under the VEA or MRCA: they must apply this Statement when assessing medical causation for varicocoele claims (section 5).\n\nKey substantive elements (examples of the listed factors, section 9)\n\n- Pre‑existing occlusion or narrowing (stenosis) of the testicular venous drainage system before clinical onset (9(1)); occlusion/stenosis is defined in the Dictionary.\n- Having had a nephrectomy within one year before the clinical onset or worsening of an ipsilateral (same‑side) varicocoele (9(2) and 9(7)).\n- Presence of an arterio‑venous fistula involving testicular arteries and pampiniform plexus veins around the time of onset/worsening (9(3) and 9(8)).\n- Coexisting systemic inflammatory diseases listed (ankylosing spondylitis or Behçet disease) at time of onset or worsening (9(4), 9(5), 9(9), 9(10)).\n- Specific physical exertion: at least 6 METs intensity for at least 6 hours per week for at least four weeks before clinical worsening (9(11)).\n- For rupture only: sexual intercourse at the time of worsening, or an event producing acute increased intra‑abdominal pressure causing a scrotal/spermatic cord haematoma within 7 days before worsening (9(12); Dictionary defines \"increased intra‑abdominal pressure as specified\").\n- Inability to obtain appropriate clinical management for varicocoele (9(13)).\n\nOfficial rationale and how it operates\n\n- The Repatriation Medical Authority (RMA) states that there is sound medical‑scientific evidence that varicocoele and death from varicocoele can be related to relevant service (section 8). The Statement translates that view into a discrete list of factors which, if shown to exist and be related to the person’s service, are sufficient to raise a reasonable hypothesis that service contributed to (or aggravated) the condition.\n- The threshold used is the statutory \"reasonable hypothesis\" standard (this instrument specifies what facts can satisfy that low‑to‑moderate evidentiary threshold). Section 10 requires any of the factors to be related to the person’s relevant service; subsections 10(2) limit the application of some factors to cases where the varicocoele existed before service and service materially contributed to or aggravated it.\n\nPractical effects, incentives and implementation issues (concrete mechanisms)\n\n- Who decides and who pays: The RMA issues this technical medical guidance (section 3). Entitlement decisions and any payments or rehabilitation measures are made under the VEA or MRCA by the relevant administering agency (the Statement is applied by decision‑makers under those Acts) (section 5). The Statement itself does not create payments — it defines the medical link that decision‑makers must accept for the \"reasonable hypothesis\" test.\n- Evidence and documentation burden: Claimants will need clinical records, imaging or operative notes to show the presence and timing of the listed factors (for example, proof of nephrectomy timing, imaging showing venous occlusion/stenosis or an arterio‑venous fistula, records quantifying physical activity or documentation of failed access to care). The METs and timing requirements (9(11)) create a measurable but potentially hard‑to‑document threshold for physical activity.\n- Administrative discretion and cross‑references: Decision‑makers must also follow other Statements of Principles where factors overlap (section 11). That means claim assessment may involve multiple Statements and cross‑checking which can add procedural steps.\n- Costs and who bears them: If the Statement leads to acceptance of causation more often, the known fiscal cost is borne by the entitlement scheme administrators (payments and rehabilitation services under VEA/MRCA). If the Statement narrows accepted links in practice, claimants bear the cost of denied claims and of producing the clinical evidence required.\n- Incentives for behaviour and clinical practice: Clinicians may be asked to record or supply specific evidence (venous imaging, operatory notes, clinician opinion linking factor timing to onset/worsening). Where the Statement lists \"inability to obtain appropriate clinical management\" as a factor (9(13)), decision‑makers will need factual evidence of system or access failures, creating potential administrative inquiry into health‑care access circumstances.\n- Risks of substitution effects and evidentiary gaps: The Statement’s reliance on certain identifiable factors (surgical history, imaging findings, defined comorbid diseases, METs thresholds) may advantage claimants who have clear records and disadvantage those with incomplete records. Some factors (e.g. venous compression from retroperitoneal mass) require diagnostic imaging to establish causation; absent such imaging, causation may be harder to establish.\n\nTrade‑offs and opportunity costs (what the instrument changes about decision‑making)\n\n- The Statement trades a general medical causation inquiry for a discrete checklist of recognized factors. That reduces open‑ended medical debates but shifts the contest to factual proof that those factors existed and were related to service (section 9 and section 10).\n- It limits legal and medical uncertainty by listing acceptable pathways to a \"reasonable hypothesis\", but it also concentrates the evidentiary question on those listed items: unlisted plausible mechanisms are less likely to succeed unless they are captured by another Statement of Principles (section 11).\n\nConcise summary points\n\n- Purpose: defines the medical links that can satisfy a \"reasonable hypothesis\" that varicocoele (or death from varicocoele) is connected to relevant service (sections 7–9).\n- Application: applies to claims under the VEA and MRCA (section 5).\n- Mechanics: uses a list of specific clinical, surgical and activity‑related factors (section 9); requires the factor(s) to be related to relevant service (section 10); interacts with other Statements where relevant (section 11).\n"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles maintaining the established scope of determining service connection for a specific medical condition. It follows the standard template used by the Repatriation Medical Authority, with no expansion beyond the traditional purpose of defining medical factors for veterans' compensation claims."},"complexity_factors":["13 distinct factors with multiple sub-factors and notes","Cross-references to other Statements of Principles for related conditions (section 11)","Technical medical terminology requiring definitions (pampiniform plexus, METs, nephrectomy, ipsilateral)","Conditional application: factors 9(6)-9(13) only apply to aggravation of pre-existing conditions, not new onset (section 10(2))","Specific limitation for factor 9(12) applying only to 'rupture of varicocoele'","Dual structure covering both clinical onset AND clinical worsening as separate pathways","Reference to external classification system (ICD-10-AM Tenth Edition) with specific ISBN and effective date"],"plain_english_summary":"This instrument updates the medical rules for when varicocoele can be presumed connected to Australian military service, replacing the 2011 guidance. It sets specific clinical and causal factors the Repatriation Medical Authority uses to form a “reasonable hypothesis” that service caused or worsened the condition.\n\nIt affects veterans and current/former defence members claiming under the VEA or MRCA and determines eligibility for treatment and compensation."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-varicocoele-reasonable-hypothesis-no-79-of-2019","history":"/api/acts/statement-of-principles-concerning-varicocoele-reasonable-hypothesis-no-79-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-varicocoele-reasonable-hypothesis-no-79-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-varicocoele-reasonable-hypothesis-no-79-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-varicocoele-reasonable-hypothesis-no-79-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-varicocoele-reasonable-hypothesis-no-79-of-2019/documents"}}