Statement of Principles concerning Barrett oesophagus (Reasonable Hypothesis) (No. 93 of 2025)

This instrument is a Statement of Principles (SoP) concerning Barrett oesophagus (Reasonable Hypothesis) (No. 93 of 2025). Mechanically it does the following.

• It replaces the previous Statement of Principles concerning Barrett’s oesophagus (No. 67 of 2016) by express repeal (section 4) and becomes effective on 24 November 2025 (section 2). The instrument is dated 24 October 2025 and signed by the Chairperson of the Repatriation Medical Authority (RMA) (front matter).
• It is made under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (VEA) (section 3) and, by express application provision, applies to claims to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 (MRCA) apply (section 5).
• It specifies the disease or kind of injury to which it relates: Barrett oesophagus and death from Barrett oesophagus. The instrument also gives a working medical definition of Barrett oesophagus as “metaplasia of the epithelium of the lower oesophagus from the normal stratified squamous epithelium to abnormal columnar epithelium” and explicitly includes metaplasia at the gastro‑oesophageal junction (section 7(2)). Although it records the ICD‑10‑AM code K22.7, it says the meaning for application of the SoP is the textual definition in section 7(2) (section 7(3)).
• It identifies the evidentiary criteria that must exist to raise a reasonable hypothesis connecting Barrett oesophagus (or death from it) to relevant service (section 9). The instrument sets out six alternative factors any one of which suffices as a minimum: (a) gastro‑oesophageal reflux disease (GORD) for at least one year before clinical onset or clinical worsening; (b) hiatus hernia before onset or worsening; (c) obesity by BMI or waist circumference thresholds sustained for at least five years before onset or worsening; (d) systemic sclerosis before onset or worsening; (e) inability to consume an average of at least 200 g/day of fruit and vegetables for at least five years before onset or worsening; or (f) inability to obtain appropriate clinical management for Barrett oesophagus before clinical worsening (section 9).
• It treats death from Barrett oesophagus as including death from a terminal event or condition that was contributed to by the person’s Barrett oesophagus, where “terminal event” is defined in Schedule 1 to include proximate or ultimate causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure or cessation of brain function (sections 7(4) and Schedule 1).
• It requires that any listed factor relied upon must be related to the person’s “relevant service”, as that term is defined in Schedule 1, which lists types of VEA and MRCA service (section 10(1) and Schedule 1).
• It addresses temporal application to clinical worsening: the clinical worsening aspects of the listed factors apply only to material contribution to, or aggravation of, Barrett oesophagus where the Barrett oesophagus was suffered or contracted before or during (but did not arise out of) the relevant service (section 10(2)).
• It provides an integration rule for factors that reference other diseases covered by separate SoPs: if a factor refers to a disease that has its own SoP, that SoP’s factors apply according to its own terms (section 11).

The RMA’s stated basis for the instrument is that there is “sound medical‑scientific evidence” indicating Barrett oesophagus and death from it can be related to relevant service (section 8). The instrument therefore operates as an evidentiary/causation framework within the VEA/MRCA claims processes: it prescribes the medical or exposure factors that, if established and linked to relevant service, raise the “reasonable hypothesis” standard used in those claims. Mechanically, it establishes the minimum factual predicates adjudicators should look for when deciding whether a claimant has raised a reasonable hypothesis; it does not itself grant entitlement, prescribe treatment, create offences, or specify benefits. The document supplies definitions and measurement rules (for example BMI calculation) that will be used in assessing whether the listed factors exist (section 9 note and Schedule 1).

This instrument organises the decision‑making threshold for Barrett oesophagus claims around a small number of legal‑medical concepts. The principal concepts, as expressed in the text, are: Barrett oesophagus (defined), death from Barrett oesophagus (as including death from a terminal event contributed to by the disease), relevant service (defined in Schedule 1), factors that must exist to raise a reasonable hypothesis (section 9), temporal rules for clinical onset and clinical worsening (sections 9 and 10), and cross‑reference to other Statements of Principles (section 11).

Barrett oesophagus is defined in concrete histological terms: metaplasia of the lower oesophageal epithelium from stratified squamous to columnar epithelium, with an express inclusion of metaplasia at the gastro‑oesophageal junction (section 7(2)). The instrument explicitly notes the ICD‑10‑AM code K22.7 but makes clear that the statutory meaning to be applied is the textual definition given (section 7(3)). This places primary weight on the physiological description rather than solely the classification code.

The “reasonable hypothesis” concept is embedded rather than separately defined. The SoP supplies the factors which must exist “as a minimum” before a reasonable hypothesis can be said to be raised connecting Barrett oesophagus (or death from it) with relevant service (section 9). In other words, at least one of the listed factors must be established and linked to service; that is the threshold for the SoP to be engaged. The instrument treats alternative factors as disjunctive: proving any one of the enumerated factors, properly related to relevant service, suffices to satisfy the SoP’s minimal requirement.

Duration and timing are explicit parts of the concept set. Some factors require a one‑year antecedent (GORD) whereas others require sustained exposure over five years (obesity, waist circumference, and inability to consume specified fruit/veg quantities). The instrument defines BMI calculation as weight divided by height squared (section 9 note), and sets specific numeric thresholds for BMI and waist circumference (section 9(3)). Where the factor is clinical worsening rather than initial onset, section 10(2) limits application to cases where the Barrett oesophagus was suffered or contracted before or during the relevant service but did not arise out of it; only then can worsening be considered as material contribution or aggravation.

“Death from Barrett oesophagus” is conceptually broader than direct death due to oesophageal carcinoma or similar outcomes. The SoP includes death from a terminal event or condition to the extent that Barrett oesophagus contributed to that terminal event (section 7(4)). The instrument defines a set of example terminal events in Schedule 1 (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function), thereby articulating the causal end‑points that may qualify as death from Barrett oesophagus.

The instrument affects claimants under the veterans’ compensation and rehabilitation frameworks and the decision‑makers who assess those claims. The express application provision states the SoP applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (section 5). Those are the statutory claim contexts in which the SoP’s factors will be used to determine whether a reasonable hypothesis exists linking Barrett oesophagus or death from Barrett oesophagus to relevant service.

The RMA frames the population of interest as veterans, members of Peacekeeping Forces, and members of the Forces under the VEA, or members under the MRCA (section 8). The Schedule 1 definition of “relevant service” further specifies the types of service that qualify: operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike or non‑warlike service under the MRCA (Schedule 1). Any person pursuing a claim based on Barrett oesophagus or death from Barrett oesophagus therefore needs to have engaged in one of those forms of relevant service and must relate the factors listed in section 9 to that service (section 10(1)).

The instrument also affects medical practitioners and experts who provide evidence for claims. The SoP sets precise medical criteria that must be shown: histological description of Barrett oesophagus (section 7(2)), diagnosis of GORD for at least one year (section 9(1)), presence of hiatus hernia (section 9(2)), BMI/waist circumference thresholds maintained for a specified five‑year period (section 9(3) and note), diagnosis of systemic sclerosis (section 9(4)), dietary insufficiency for five years (section 9(5)), and the inability to obtain appropriate clinical management (section 9(6)). Medical practitioners will be the primary source of documentary evidence establishing these items and their timing relative to clinical onset or worsening.

Administrators and decision‑makers within the veterans’ entitlements and MRCA systems are affected because they must apply the SoP when determining whether a reasonable hypothesis has been raised. The instrument does not itself specify how adjudicators must weigh or quantify evidence beyond the listed criteria, but it does require that factors relied upon be “related to the relevant service rendered by the person” (section 10(1)). Decisions will therefore have to examine service records as well as medical records to establish that link, and where a factor refers to another disease covered by a separate SoP, administrators will need to consult and apply that other SoP (section 11).

The instrument also affects families or estates where death from Barrett oesophagus is claimed, because the definition of death includes death from a terminal event to which Barrett oesophagus contributed (section 7(4) and Schedule 1). Practically, that will necessitate production of death certificates, clinical records documenting the terminal event, and evidence connecting that event to Barrett oesophagus.

This instrument itself is primarily an evidentiary instrument; it does not articulate new criminal offences, direct financial obligations, or administrative penalties. Its operative effect is to set mandatory minimum factors that must be shown to raise a “reasonable hypothesis” connecting Barrett oesophagus or death from Barrett oesophagus with relevant service. Accordingly the principal duties and rights arise as follows.

Duties placed on claimants and their advisers

• A claimant who relies on this SoP must establish at least one of the factors listed in section 9, and must show that the existence of that factor was related to their relevant service (section 10(1)). This is a factual duty to produce evidence of both the factor and its relationship to service.
• Where the factor relied upon concerns clinical worsening, the claimant must show the Barrett oesophagus was suffered or contracted before or during the relevant service and did not arise out of the relevant service; only then can clinical worsening be considered a material contribution or aggravation (section 10(2)). That places a duty to establish the chronology of disease onset and the timing of service in relation to onset.
• If a claimed factor refers to a disease or injury that has its own SoP, the claimant must engage with that other SoP and satisfy its terms because the other SoP applies in accordance with its own terms (section 11). This may impose an additional factual burden where the factor points to an interlocking medical condition.

Duties on medical and expert witnesses

• Medical authors of supporting evidence must provide records or opinions that operationalise the instrument’s definitions and measurement rules. Examples: histological proof of metaplasia consistent with section 7(2); documentation of GORD for at least one year prior to clinical onset/worsening (section 9(1)); records of hiatus hernia (section 9(2)); BMI and waist circumference measurements over the five year period or evidence permitting reconstruction of those measures (section 9(3) and note); diagnosis dates for systemic sclerosis (section 9(4)); dietary assessments sufficient to support an inability to consume an average of 200 g/day fruit/veg for five years (section 9(5)); and evidence about access to clinical management (section 9(6)).

Rights conferred or implicated

• The SoP confers no substantive entitlement directly; rather it shapes a legal right in the sense that proving one or more of the specified factors, properly related to relevant service, meets the minimum threshold for a “reasonable hypothesis” under the VEA and MRCA claim processes. The claimant thereby gains the procedural and evidentiary advantage of having met the SoP’s predicate for causation. The instrument’s explicit criteria clarify what must be shown to raise that threshold.

The instrument contains no criminal sanctions, fines, or administrative penalty provisions. It is a Statement of Principles issued under subsection 196B(2) of the VEA (section 3), designed to provide an evidence framework for the assessment of claims under section 120A of the VEA and section 338 of the MRCA (section 5). The instrument operates as a statutory evidentiary tool within those claims processes; enforcement in the traditional regulatory sense (for example, imposition of penalties for non‑compliance) is not within the text.

Implementation and enforcement in practice therefore occur through administrative decision‑making in the relevant claims processes. That is, adherence to the SoP will be enforced by adjudicators by way of acceptance or rejection of a claim’s causal linkage based on whether the claimant has established at least one of the prescribed factors and related it to relevant service (sections 9 and 10). The instrument does not itself prescribe the procedural remedies, appeal rights or sanctions available where a decision is made in reliance on the SoP; those matters are governed by the VEA, MRCA and associated administrative processes which are outside the SoP text. The SoP does, however, set the criteria that enforcement bodies will apply when considering the threshold of a reasonable hypothesis.

Because the instrument includes definitional content (for example the textual definition of Barrett oesophagus (section 7(2)), BMI calculation (section 9 note), and the list of terminal events (Schedule 1)), administrative compliance will involve ensuring evidence aligns with those definitions. Failure to present evidence that corresponds to the SoP’s definitions will likely result in the claimant failing to satisfy the required threshold; this is the instrument’s principal enforcement mechanism.

The instrument also creates an interlocking effect with other Statements of Principles: where a listed factor refers to an injury or disease that is itself governed by another SoP, the other SoP applies according to its terms (section 11). In practice this means administrative enforcement may require cross‑checking multiple SoPs to determine whether the factors are satisfied.

Finally, the instrument contains no auditing, inspection, or record‑keeping obligations beyond those implicitly required for proving the listed factors. It likewise contains no notice provisions as to how the RMA or decision‑makers should publicise changes beyond the formal publication and commencement clauses (sections 1-5). In sum, enforcement is administrative and evidentiary rather than punitive, and the instrument provides the criteria by which administrative enforcement is carried out within the relevant statutory claims processes.

The SoP is explicitly made under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (VEA) (section 3) and applies to claims to which VEA section 120A or MRCA section 338 apply (section 5). Therefore its interaction with other law is primarily as a statutory evidentiary instrument within the VEA and MRCA schemes.

Primary statutory interaction

• The SoP must be used in the assessment of claims under the specified provisions of the VEA and MRCA (section 5). That situates it as an evidentiary tool in administrative decision‑making under those Acts. Any procedural rules, entitlement criteria, or appeal mechanisms in the VEA and MRCA remain the governing legal architecture; the SoP informs the causation/medical assessment component of that architecture.

Interaction with other Statements of Principles

• The instrument contains an express cross‑reference rule: if a factor in section 9 refers to an injury or disease covered by another SoP determined under subsection 196B(2) of the VEA, then the factors in that other SoP “apply in accordance with the terms of that Statement of Principles as in force from time to time” (section 11). This creates direct interplay between SoPs: where conditions overlap, decision‑makers must read and apply multiple SoPs together, according to their respective terms.

Interaction with medical classification systems

• The SoP notes that Barrett oesophagus attracts ICD‑10‑AM code K22.7 but specifies that for the purposes of the SoP, the meaning given in section 7(2) controls (section 7(3)). It also states that a reference to an ICD‑10‑AM code is a reference to the code assigned in the particular specified edition (section 7(3) note). This means the instrument acknowledges an external medical classification but mandates that the statutory textual definition is the operative description for claims.

Interaction with definitions and service law

• The Schedule 1 definitions place “relevant service” within the categories of service recognised under the VEA and MRCA (operational, peacekeeping, hazardous, British nuclear test defence service, warlike, non‑warlike). That means the SoP interacts directly with the statutory definitions of service for entitlements under the VEA and MRCA. Whether a particular person’s service qualifies as “relevant service” will be determined under those Acts, and the SoP’s factors must be related to that service to raise the reasonable hypothesis (section 10(1) and Schedule 1).

This Statement of Principles is dated 24 October 2025 and commences on 24 November 2025 (front matter and section 2). It is made under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (section 3). The instrument expressly repeals the prior Statement of Principles concerning Barrett’s oesophagus (Reasonable Hypothesis) (No. 67 of 2016), Federal Register of Legislation No. F2016L01135 (section 4). No other amendments, transitional arrangements or savings provisions are included in the instrument text.

What the instrument therefore records about amendment history is limited but specific:

• Repeal: section 4 removes the earlier No. 67 of 2016 SoP from force. Any claims assessed after the commencement date will be considered against this new SoP (No. 93 of 2025) rather than the repealed text.
• Commencement timing: there is a defined commencement date (section 2). The period between the date of signing (24 October 2025) and commencement (24 November 2025) provides a one‑month interval before the new SoP applies.
• No transitional clauses: the instrument contains no express transitional language dealing with claims lodged before commencement but decided afterwards, or with matters already in progress under the repealed SoP. The absence of transitional provisions means administrative decision‑makers will need to apply existing statutory rules or administrative practice about how new SoPs operate in relation to pending claims governed by the VEA/MRCA frameworks; such practices are not detailed in this instrument.

Because the SoP also contains a cross‑reference provision (section 11), its operation may be affected by subsequent amendments to other SoPs that it references, since it instructs that where a factor refers to another injury/disease covered by another SoP, “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” (section 11). That language explicitly contemplates that other SoPs may change over time and that those changes will affect how the cross‑referenced factors operate.

Finally, the instrument does not itself provide a scheduled review date or mechanism for amendment. Any future amendments would be made by the RMA under the same statutory power (s196B(2) VEA) and would need to be published and commenced in accordance with statutory and administrative requirements. The present instrument’s narrow amendment history therefore consists of its repeal of No. 67 of 2016 and its own commencement, with future change to be effected by separate instruments.

The text of this Statement of Principles contains no citations to judicial decisions, no summaries of case law, and no express references to litigation. The Repatriation Medical Authority states its view that “there is sound medical‑scientific evidence” indicating Barrett oesophagus and death from Barrett oesophagus can be related to relevant service (section 8), but no cases are cited or discussed in the instrument itself.

Consequently, within the four corners of this instrument there is no litigation record to summarise. The instrument does not identify any judicial challenges to either this instrument or the SoP it replaces, nor does it reserve rights or prescribe outcomes in relation to ongoing litigation. The absence of litigation references means that any judicial interpretation or administrative review of this SoP will depend on external litigation under the VEA or MRCA frameworks rather than content within the SoP.

Two practical observations flow from this silence in the instrument:

• First, the instrument is purely administrative and evidentiary; any legal challenge to decisions that apply the SoP will arise from decisions made under the VEA or MRCA, not from the SoP text itself. The SoP sets criteria to raise a reasonable hypothesis; how decision‑makers apply those criteria in individual cases will determine whether litigation or review occurs.
• Second, because the instrument cross‑references other SoPs (section 11) and rests on statutory concepts like “relevant service” and “reasonable hypothesis”, litigation or tribunal decisions that interpret those statutory concepts or other SoPs could indirectly affect how this SoP is applied. However, the instrument itself does not catalogue or purport to rely upon any such authorities.

For users preparing for possible litigation or review, the immediate implication is that any argument about the SoP’s application must be grounded in the text of this instrument (sections 7-11 and Schedule 1), the governing provisions of the VEA and MRCA, and the evidence in the particular claim, because the instrument provides no litigative scaffolding or cited precedents.

The instrument’s concise drafting contains a number of specification points and potential practical pitfalls for claimants, advisers and decision‑makers. These are “gotchas” where outcomes can turn on precise technicalities in the text.

Temporal linking and the phrases “clinical onset” and “clinical worsening”

• The factors in section 9 are tied to temporal references: “before clinical onset or clinical worsening.” The instrument does not define “clinical onset” or “clinical worsening” further. Hence, whether a particular medical record supports a claimant depends on precise dating of onset or worsening and whether evidence demonstrates that the required antecedent duration (one year for GORD, five years for obesity/dietary insufficiency) is satisfied prior to that onset or worsening (sections 9(1), 9(3), 9(5)). This creates evidentiary risk where historical clinical notes are sparse or undated.

The clinical worsening limitation for service‑timing

• Section 10(2) applies clinical worsening only to material contribution to, or aggravation of, Barrett oesophagus where the person’s Barrett oesophagus was suffered or contracted before or during (but did not arise out of) the person’s relevant service. Therefore, if a claimant’s Barrett oesophagus arose out of the relevant service (that is, is alleged to have been caused by service), clinical worsening cannot be used in the same way under section 10(2) to establish material contribution. That is a fine textual distinction that affects claim framing.

Measurement of obesity and BMI

• The obesity factor requires either a BMI of 30 or greater, or waist circumference thresholds (males > 102 cm, females > 88 cm), sustained “for at least the 5 years immediately preceding clinical onset or clinical worsening” (section 9(3)). The SoP gives the BMI formula (weight/height^2). Practically, claimants must provide repeated objective measures or credible reconstruction of measures over five years. A single or late‑dated measurement may not suffice. The instrument does not provide tolerance for proximate measurement gaps.

Dietary threshold and reconstructing consumption

• Section 9(5) requires “inability to consume an average of at least 200 g/day of any combination of fruit and vegetables, for at least the 5 years before clinical onset or clinical worsening.” This is a demanding nutritional threshold to prove over a five‑year span. Medical or social histories must be detailed and may require expert dietary assessment. The phrase “inability to consume” is not defined; it could encompass physical inability, access limitations, or other causes. The lack of an explicit definition raises uncertainty about acceptable evidence.

Compliance here means preparing and presenting evidence that satisfies the instrument’s minimum criteria so that a reasonable hypothesis is raised connecting Barrett oesophagus, or death from it, with relevant service. The SoP sets out the necessary items and measurement rules; the following practical steps flow directly from the relevant provisions and should be adopted by claimants, medical witnesses and advisers.

Establish the basic diagnosis and its timing

• Obtain pathology and clinical reports that confirm Barrett oesophagus as defined in section 7(2): histological evidence of metaplasia of lower oesophageal epithelium from stratified squamous to columnar epithelium, with specific note if metaplasia is at the gastro‑oesophageal junction. Ensure reports indicate dates of diagnosis and any prior endoscopy/biopsy results that help define “clinical onset” and any subsequent dates that could be relied on for “clinical worsening” (section 7(2), section 9).

For death claims, document terminal event and contribution

• If death is claimed under the SoP, obtain the death certificate and clinical records for the terminal admission or event. Demonstrate that Barrett oesophagus contributed to the terminal event as required by section 7(4) and Schedule 1. Where the terminal event falls within the Schedule 1 examples (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function), link clinical notes or expert opinion showing contribution rather than mere concurrence.

Prove at least one listed factor and its timing relative to onset/worsening

• Gastro‑oesophageal reflux disease (GORD): For section 9(1), obtain records confirming GORD and its duration of at least one year prior to clinical onset or clinical worsening. Prescription records (proton pump inhibitor use), specialist letters, endoscopy reports and primary care notes can establish continuous or recurrent GORD with dates.
• Hiatus hernia: For section 9(2), obtain imaging or endoscopy reports that document hiatus hernia and the date of diagnosis that precedes clinical onset/worsening.
• Obesity/BMI or waist circumference: For section 9(3), assemble objective BMI and waist circumference data over the five years immediately preceding clinical onset/worsening. Use serial clinic records, occupational health checks, defence force medical records, or other reliable records. Apply the BMI formula given in the instrument (weight in kg divided by height in m squared) when reconstructing BMI (section 9 note). If direct measures are missing, obtain expert opinion explaining why contemporaneous measures can be reliably estimated from available records.