Statement of Principles concerning umbilical hernia, peri-umbilical hernia and para-umbilical hernia (Balance of Probabilities) (No. 92 of 2025)

This instrument is a Statement of Principles made by the Repatriation Medical Authority under subsection 196B(3) of the Veterans' Entitlements Act 1986 (the VEA), setting out medical‑causation criteria for umbilical hernia, peri‑umbilical hernia and para‑umbilical hernia and death from those conditions (No. 92 of 2025). It commences on 24 November 2025 (s1, s2, signed 24 October 2025). The Statement repeals the earlier Statement of Principles concerning umbilical hernia (No. 94 of 2016) (s4).

Mechanically, the Statement lists the specific medical definitions and the factual factors that must be present, on the balance of probabilities, for the medical condition to be regarded as related to a person’s relevant service for the purposes of certain claims under the VEA and the Military Rehabilitation and Compensation Act 2004 (MRCA). It applies to claims "to which section 120B of the VEA or section 339 of the MRCA applies" (s5). The Repatriation Medical Authority states, as the legal standard for deciding causation under this instrument, that "on the sound medical‑scientific evidence available" it is of the view that it is "more probable than not" that these hernias and related death can be related to relevant service (s8). The document therefore functions as a medical‑causation template used by decision makers deciding entitlement under the listed statutory provisions.

Substantively, the Statement defines the covered conditions as a protrusion of intra‑abdominal tissue through a defect in the abdominal wall in the region of the umbilicus and expressly excludes incisional hernia at the umbilicus (s7(2)). It sets out four alternative factors any one of which, if related to the person’s relevant service, will satisfy the causation link on a balance of probabilities: BMI 30 or greater at clinical onset or clinical worsening; chronic elevation of intra‑abdominal pressure at clinical onset; acute or chronic elevation of intra‑abdominal pressure at clinical worsening; and inability to obtain appropriate clinical management before clinical worsening (s9). The Statement also clarifies how clinical worsening is treated in relation to pre‑existing hernia and cross‑references other Statements of Principles where factors refer to other injuries or diseases (s10, s11).

The instrument is an administrative medical standard, not a statute creating offences or penalties. It prescribes how medical causal links are to be assessed for relevant claims, and therefore shapes who is eligible for benefits and the type of medical and service evidence decision makers must examine.

The Statement centres on causation and eligibility for veterans’ benefits by specifying medically grounded triggering facts that, if proved, establish a connection between umbilical/ peri‑umbilical/ para‑umbilical hernia (and death from those hernias) and a person’s relevant service. The core concepts are as follows and are expressed in the instrument’s text.

• Definition of the covered condition. The Statement defines "umbilical hernia, peri‑umbilical hernia and para‑umbilical hernia" as a protrusion of intra‑abdominal tissue through a defect in the abdominal wall in the region of the umbilicus, and it excludes incisional hernia located at the umbilicus (s7(2)). The Statement notes ICD‑10‑AM codes K42.0, K42.1, K42.9 are associated with these conditions but specifies that the meaning for the instrument is the statutory definition in s7(2) (s7(3)).

• Death from the condition. The term includes death from a terminal event or condition that was contributed to by the person’s hernia (s7(4)). "Terminal event" is defined in Schedule 1 and includes proximate or ultimate causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function (Schedule 1).

• Standard of proof and evidential basis. The Authority states that, on the available medical‑scientific evidence, it is of the view that it is "more probable than not" that these conditions can be related to relevant service (s8). That phrase signals the balance of probabilities standard for causal connection within the administrative determination process governed by the VEA and MRCA provisions cited in s5.

• Factors that establish the causal link. Section 9 lists alternative factors; at least one must exist and be related to the person’s relevant service (s9, s10). These are: BMI of 30 or greater at clinical onset or clinical worsening (with BMI formula provided); chronic elevation of intra‑abdominal pressure at clinical onset; acute or chronic elevation of intra‑abdominal pressure at clinical worsening; and inability to obtain appropriate clinical management for the hernia before clinical worsening (s9). The instrument provides illustrative examples of conditions that can cause chronic or acute elevation of intra‑abdominal pressure (s9 notes).

• Relationship to service. Section 10 requires that any factor relied on must be related to the person’s relevant service, and it places a temporal and causal limitation on the "clinical worsening" factors: they apply only where the hernia was "suffered or contracted before or during (but did not arise out of) the person’s relevant service" (s10(2)). The Schedule defines "relevant service" to include eligible war service (other than operational service), defence service (other than hazardous service and British nuclear test defence service) under the VEA, and peacetime service under the MRCA (Schedule 1).

Directly affected persons are claimants seeking a determination that umbilical, peri‑umbilical or para‑umbilical hernia (or death from those conditions) is related to their relevant service for the purposes of the VEA or MRCA. The instrument applies to claims "to which section 120B of the VEA or section 339 of the MRCA applies" (s5). Those provisions, as referenced in the Statement, set the statutory context in which the Repatriation Medical Authority’s Statement will be applied by the decision making agencies administering veteran entitlements and rehabilitation compensation.

Practitioners and advisers who will need to work with this Statement include medical practitioners who provide clinical diagnoses and expert reports, legal advisers and claims advocates preparing evidence of onset, worsening and service ties, and decision makers in the Department or agency implementing the VEA and MRCA. Administrative medical assessors will use the factors in s9 to determine whether a medical condition is connected to relevant service.

Service organisations and the persons who provide or withhold medical treatment for serving members or ex‑members may be affected indirectly because the Statement expressly recognises "inability to obtain appropriate clinical management" as a factor that can establish a causal link (s9(4)). That means evidence about access to care, timing of treatment, and system constraints during or after service will be relevant to entitlement assessments.

The Statement also affects how records must be compiled and marshalled. The instrument requires timing‑specific evidence: BMI at "the time of clinical onset or clinical worsening", evidence that an intra‑abdominal pressure‑raising condition existed "at the time of clinical onset" or "at the time of clinical worsening", and proof that a hernia pre‑dated or occurred during service where clinical worsening is relied upon (s9, s10). Consequently, historical medical records, service health records, diagnostic imaging and treatment notes acquire elevated evidentiary value.

Decision makers applying this Statement are affected by the scope and precision of the definitions it contains. For example, the Statement excludes incisional hernia located at the umbilicus (s7(2)(b)). It also cross‑references other Statements for factors that invoke other injuries or diseases (s11). Therefore there is an administrative workload for linking evidence to multiple Statements where a factor invokes another condition.

The Statement does not create criminal or civil penalties. Its effect is confined to the administrative assessment of causation for entitlement decisions under the cited statutory provisions. It imposes no express regulatory obligations on non‑claimant third parties beyond evidential relevance.

The instrument itself does not create new statutory duties or rights in the sense of obligations enforceable by fines. Instead, it prescribes the medical‑causation criteria that decision makers must apply when determining whether the specified hernia conditions, or death from them, are related to a person’s relevant service for claims under the VEA and MRCA (s5, s8). The principal operative duties and rights flow from that application.

Duties of decision makers and medical assessors

• Apply the Statement when assessing causation for claims that fall under s120B of the VEA or s339 of the MRCA. The Statement sets the evidentiary thresholds and the applicable factors (s5, s9). Decision makers are expected to use these factors as the Repatriation Medical Authority’s guidance as to what is "more probable than not" medical causation (s8).

• Interpret the defined terms in the Statement. The Statement provides definitions (Schedule 1) and specific exclusions (s7(2)). Decision makers must treat the statutory definition in s7(2) as the meaning for the instrument, even though ICD‑10‑AM codes are noted (s7(3)).

Rights and entitlements of claimants

• Claimants have the right to have their medical condition assessed against the factors in s9. If a claimant establishes, on the balance of probabilities, that at least one factor existed and that it was related to their relevant service, the Statement directs that a causal link can be found (s8, s9, s10).

• Where a factor refers to an injury or disease covered by another Statement, claimants can rely on the terms of that other Statement in accordance with s11. This is a procedural right to have interconnected medical conditions assessed consistently across Statements.

Evidence and burden considerations

• The Statement implicitly places an evidential burden on claimants to prove that at least one of the factors existed "at the time" specified (s9) and that the factor is related to their relevant service (s10(1)). The Statement sets the standard of proof for causation as balance of probabilities via the Authority’s view in s8.

• For BMI, the Statement specifies how it is calculated (W/H2) and that a BMI of 30 or greater at the time of clinical onset or clinical worsening is one of the alternative factors (s9, BMI note). That creates a duty on claimants or medical practitioners to provide measured weight and height records or reliable contemporaneous evidence to support the BMI value at the relevant time.

The Statement contains no criminal sanctions, pecuniary penalties, licensing conditions, or express enforcement mechanisms. Its legal effect is advisory and determinative within the administrative decision‑making framework established by the VEA and MRCA: the instrument prescribes how the Repatriation Medical Authority considers medical causation should be established for particular claims (s3, s5, s8). Enforcement therefore occurs indirectly through its role in entitlement determinations under the VEA and MRCA.

Practical enforcement mechanism

• Administrative effect through entitlement decisions: the primary "enforcement" is that the Statement will be applied by the agencies responsible for processing claims under s120B VEA and s339 MRCA. If a claim meets the causation criteria set out in the Statement, an entitlement decision under the relevant Act will follow the causation finding; if not, entitlement may be denied. The instrument itself does not specify the decision maker’s procedures or sanctions for non‑compliance by third parties (s5, s8).

Absence of inspection or compliance regime

• The Statement does not create inspection powers, reporting obligations, or compliance audits. It neither prescribes obligations for medical practitioners beyond providing evidence when called upon nor imposes duties on hospitals, employers or superannuation funds. The only operational link is the evidentiary value of such records where they bear on the factors listed (s9, Schedule 1 definitions).

No penalties for misstatement in evidence within the instrument

• The Statement does not assign penalties for false or misleading evidence. Any sanctions for non‑compliance, false statements or fraud would be those available under the VEA, MRCA or general criminal law, but such provisions are not part of this instrument and are not stated here.

Relevance to administrative review and appeal

• The Statement will be used in decisions that are themselves subject to the review and appeal mechanisms provided in the VEA and MRCA. The instrument does not create or alter review processes; those are governed by the originating Acts. Consequently, the main enforcement risk for affected persons is administrative: a decision based on whether the Statement’s factors are satisfied can be challenged through the statutory remedies available under the VEA or MRCA.

Summary

• There are no direct penalties or enforcement provisions contained in this Statement. Its operational effect is to structure the medical causation assessment in claims processing; enforcement takes the form of the application of those assessments in entitlement determinations under the VEA and MRCA, with any challenge to resulting decisions proceeding under the statutory review avenues in those Acts rather than under this Statement.

The Statement is made under subsection 196B(3) of the Veterans' Entitlements Act 1986 (s3) and expressly applies to claims to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies (s5). It therefore interacts administratively with the VEA and MRCA by providing the Repatriation Medical Authority’s medical causation criteria that decision makers apply when determining whether a condition is related to relevant service for statutory entitlement purposes.

Relationship with statutory entitlement frameworks

• The Statement does not itself create entitlement or alter the substantive eligibility rules of the VEA or MRCA; rather it is a medical evidentiary instrument used within the framework those Acts provide. The application clause (s5) ties the instrument’s relevance to specific claim provisions in the VEA and MRCA, so its legal force is dependent on those Acts and the agencies that administer them.

Cross‑reference to other Statements of Principles

• Section 11 provides a mechanism for inter‑Statement interaction: if a factor in this Statement refers to an injury or disease that is the subject of another Statement determined under subsection 196B(3) of the VEA, then that other Statement’s factors "apply in accordance with the terms of that Statement of Principles as in force from time to time" (s11). This creates an explicit dependency and requires decision makers to consult, and apply, other relevant Statements where a factor invokes another covered condition.

Interaction with medical classification systems and coding

• The Statement notes the ICD‑10‑AM codes (K42.0, K42.1, K42.9) associated with the conditions (s7(3)), but it also states that "in applying this Statement of Principles the meaning of umbilical hernia, peri‑umbilical hernia and para‑umbilical hernia is that given in subsection (2)" (s7(3)). The instrument therefore uses ICD coding as a cross‑reference while preserving the statutory definition as determinative for administrative purposes.

Interaction with health records and clinical evidence

• The Statement’s factors require evidence about BMI at particular times, existence of conditions that raise intra‑abdominal pressure, and access to clinical management. Those evidentiary requirements mean that health records, diagnostic imaging, hospital notes, and service medical records are directly relevant. The Statement does not modify privacy, health‑information or record‑keeping laws, but it increases the practical import of such records in claims under the VEA and MRCA.

This instrument itself records a limited amendment history within the body of the text. The key amendment action contained in the instrument is the repeal of the earlier Statement of Principles concerning umbilical hernia (Balance of Probabilities) (No. 94 of 2016), Federal Register of Legislation No. F2016L01676 (s4). The new Statement is identified as No. 92 of 2025.

Dates and commencement

• The instrument was signed by the Chairperson of the Repatriation Medical Authority on 24 October 2025 and has a commencement date of 24 November 2025 (s2; signature page). That one‑month gap establishes the date from which the new Statement has legal effect.

Authority for change

• The Statement is made under subsection 196B(3) of the Veterans' Entitlements Act 1986 (s3). The instrument therefore exercises the statutory power granted to the Repatriation Medical Authority to determine Statements of Principles that apply to the VEA claims process and, where applicable, MRCA claims per the application clause (s5).

Textual changes relative to prior Statement

• The instrument itself does not set out a comparative table of amendments to the prior 2016 Statement. The only explicit historical action recorded is repeal. Any textual differences between the 2016 and 2025 Statements are not annotated in this document; practitioners must compare the two instruments if they need to identify what has changed in wording, examples, factor thresholds or definitions.

No transitional provisions stated

• The instrument contains no express transitional or saving provisions to govern claims already lodged or decisions already made under the previous Statement. The absence of transitional language means the administrative agencies applying the VEA and MRCA will need to determine how to treat ongoing matters and past decisions consistent with the governing statutes and ordinary principles of administrative law.

No amendment schedule or sunset

• The instrument does not include a review date, sunset clause, or automatic amendment mechanism. It is therefore operative until repealed or replaced by a future Statement made under the same statutory power (s3).

Record and registration

• The instrument references Federal Register details for the repealed 2016 Statement, but does not itself include a Federal Register number on the face of the presented text. The signature page and formal headings indicate it is intended as an official Repatriation Medical Authority determination.

The text of this Statement does not record any litigation history. It contains no references to judicial decisions, disputes, or administrative appeals. The only historical instrument it cites is the earlier Statement of Principles concerning umbilical hernia (No. 94 of 2016), which it repeals (s4); no court cases or tribunal determinations are mentioned in association with that prior instrument.

Implications of silence on litigation

• Because the instrument does not include any litigation references, users should treat the Statement as a fresh administrative instrument. Any litigation arising from decisions applying this Statement would be recorded in external records (court or tribunal files) and are not contained in this text.

Expectations for future disputes

• In practice, entitlement decisions that rely on Statements of Principles can be contested under the review mechanisms provided in the VEA and MRCA regimes. The Statement provides the medical framework that will be applied by decision makers; disagreements about factual findings (for example, whether a claimant had BMI 30 or greater at the relevant time, whether an intra‑abdominal pressure‑raising condition existed, or whether there was an inability to obtain clinical management) may be litigated through available administrative review and appeal channels. Those procedural routes are outside the text of this Statement and are governed by the originating statutes.

No reported precedents in instrument

• The absence of cited cases or precedent in the Statement means it should be read as an authoritative medical/scientific view from the Repatriation Medical Authority rather than as an account of contested judicial interpretation. Any case law that later interprets the Statement or its application will need to be located in external legal databases or tribunal records, which are not part of this instrument.

Practical note for advisers

• Because the Statement does not summarise prior litigation, advisers should not assume settled judicial interpretations of its terms exist. Where precise interpretation of terms such as "inability to obtain appropriate clinical management" or the temporal limitation in s10(2) is critical, parties should treat such issues as potentially contestable at review and prepare evidence accordingly.

In short, the instrument itself records no litigation history. Any disputes arising from its application will be found in administrative and judicial records outside this document.

This Statement contains several technical features and drafting choices that create practical risks, evidentiary traps, or interpretive ambiguities for claimants, advisers and decision makers. These are not value judgments but concrete operational points tied to specific provisions.

1. Distinction between defined condition and ICD coding

• The Statement notes ICD‑10‑AM codes K42.0, K42.1, K42.9 correspond to the conditions, but it expressly states that "in applying this Statement of Principles the meaning of umbilical hernia, peri‑umbilical hernia and para‑umbilical hernia is that given in subsection (2)" (s7(3)). This means a diagnostic code alone is not decisive; decision makers must apply the statutory definition (s7(2)). Relying solely on billing or coding labels in hospital records without demonstrating the clinical description in s7(2) is a risk.

2. Exclusion of incisional hernia at the umbilicus

• The instrument excludes "incisional hernia located at the umbilicus" (s7(2)(b)). Cases where records refer to an umbilical hernia but the underlying pathology is an incisional hernia will fall outside the Statement. Claimants and clinicians must differentiate these conditions in contemporaneous documentation.

3. Temporal and causal limit on "clinical worsening"

• Section 10(2) states the clinical worsening factors in s9 apply only where the person's hernia "was suffered or contracted before or during (but did not arise out of) the person's relevant service." The parenthetical "but did not arise out of" is a precise limitation: clinical worsening may only be used to show material contribution/aggravation if the hernia pre‑existed or occurred during service but was not caused by service. This creates an evidentiary complexity: if the hernia arose out of service, the clinical worsening route is not available. Practitioners must evidence the date and cause of the initial hernia carefully.

4. "Inability to obtain appropriate clinical management" is undefined

• s9(4) includes inability to obtain appropriate clinical management as an alternative factor, but the Statement offers no definition or threshold for what constitutes "inability" or "appropriate" management. That absence leaves considerable scope for administrative interpretation and dispute about what evidence satisfies the element. Parties relying on this factor need to document attempts to access care, reasons care was not obtained, and why available care was not appropriate.

Compliance in this context means assembling and presenting the medical and service evidence necessary to satisfy, on the balance of probabilities, that at least one of the Statement’s factors existed and that the factor is related to the person’s relevant service as defined in the Schedule (s9, Schedule 1). The Statement itself does not prescribe procedural forms; compliance occurs through ensuring that decision makers have the material needed to apply the Statement’s thresholds.

Key steps for claimants and advisers

1. Establish the diagnosis using the instrument’s definition

• Ensure clinical documentation describes the condition as "a protrusion of intra‑abdominal tissue through a defect in the abdominal wall in the region of the umbilicus" (s7(2)). Do not rely solely on an ICD‑10‑AM code; tie the diagnosis explicitly to the statutory wording (s7(3)).

2. Demonstrate timing of onset and, if relevant, of clinical worsening

• For BMI and intra‑abdominal pressure factors, the Statement requires the state at "the time of clinical onset or clinical worsening" (s9). Collect contemporaneous medical records, diagnostic imaging reports, surgical notes, emergency department records, and GP notes that show dates of first presentation, documented enlargement, obstruction, incarceration, strangulation or rupture where relevant (s7 note).

3. Provide BMI evidence where relied upon

• Where relying on the BMI factor, submit contemporaneous weight and height measurements or hospital notes that allow calculation using W/H2 as specified in the BMI note to s9. Where measurements are not contemporaneous, provide an explanation and supporting evidence for any retrospective estimation.

4. Document conditions raising intra‑abdominal pressure

• Where relying on chronic or acute elevation of abdominal pressure, provide medical evidence of those conditions or events at the relevant time (for example, records demonstrating ascites, peritoneal dialysis, significant coughing episodes, vomiting, heavy lifting episodes, pregnancy or straining due to constipation). Use the examples in the Statement as a checklist but be prepared to justify other causes if relied upon (s9 notes).

5. If relying on "inability to obtain appropriate clinical management," build a contemporaneous record