Statement of Principles concerning cardiac myxoma (Reasonable Hypothesis) (No. 83 of 2025)

The instrument organises around a small set of legal and medical concepts linking service to disease. The core concepts are: the defined disease (cardiac myxoma), death from cardiac myxoma, relevant service, factors that must exist to raise a reasonable hypothesis, relationship of those factors to service, and interaction with other Statements of Principles.

• Cardiac myxoma: The instrument defines cardiac myxoma precisely as a benign neoplasm of the heart composed of primitive connective tissue cells and stroma resembling mesenchyme (s7(2)). It notes usual anatomical locations (atria, sometimes ventricles) in an explanatory note and records that ICD‑10‑AM code D15.1 is associated with the condition, but it establishes the textual statutory meaning as controlling for the SoP’s purposes (s7(2)-(3)).

• Death from cardiac myxoma: The SoP includes death from a terminal event or condition contributed to by the person’s cardiac myxoma; the Schedule defines terminal event by a set of proximate or ultimate causes of death (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) (s7(4); Schedule).

• Relevant service: The instrument applies only where the person rendered relevant service as defined in the Schedule , which cross‑refers to categories under the VEA and the MRCA, including operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike or non‑warlike service under the MRCA (Schedule: relevant service).

• Factors to raise a reasonable hypothesis: Section 9 lists three discrete factors, of which at least one must exist to meet the SoP threshold. They are: (1) having a heart transplant before clinical onset; (2) blunt force trauma to the chest immediately preceding clinical worsening; and (3) inability to obtain appropriate clinical management for cardiac myxoma before clinical worsening (s9(1)-(3)). The instrument includes a clinical note explaining how blunt force trauma can cause embolisation of myxoma fragments with resulting ischaemia and infarction.

• Relationship to service: The instrument requires the existence of any listed factor to be related to the person’s relevant service (s10(1)). It further clarifies that the “clinical worsening” aspects of factors apply only to material contribution to, or aggravation of, cardiac myxoma where the myxoma was suffered or contracted before or during, but did not arise out of, the person’s relevant service (s10(2)).

• Interaction with other Statements: If a factor in s9 refers to an injury or disease already covered by another SoP, the factors in that other SoP apply as in force from time to time (s11).

These concepts structure how a decision‑maker will assess causation: the legal test is the “reasonable hypothesis” threshold and the instrument specifies the factual/medical findings required to meet that threshold for cardiac myxoma claims. The definitions and cross‑references constrain which events count as relevant service and which subsequent medical events count as death from the condition.

The instrument applies to persons lodging claims under the VEA or MRCA where those claims are caught by the specific provisions identified: section 120A of the VEA or section 338 of the MRCA (s5). The Schedule defines relevant service to include multiple categories of veteran or serving personnel: operational service, peacekeeping service, hazardous service, British nuclear test defence service under the VEA, and warlike or non‑warlike service under the MRCA (Schedule: relevant service). Therefore the immediate population affected comprises veterans and members of Forces who have rendered the categories of service listed.

Who decides: the Repatriation Medical Authority issues this SoP under its statutory power (s3). The instrument does not itself decide individual entitlements; it sets the medical‑causation criteria that are used in the statutory claims framework established by the VEA and MRCA. The instrument’s reach is therefore to the decision processes that adjudicate claims under the referenced provisions (s5). The text does not identify particular administrative decision‑makers or payment agencies, but the instrument’s purpose (to apply to claims under the VEA and MRCA) means it will be used by those agencies that assess entitlement under those Acts.

Who pays: the SoP does not specify funding or payments. It is a causation instrument applied within the statutory entitlement schemes created by the VEA and MRCA (s5). Any payments or rehabilitation obligations arise from those Acts, not from this SoP itself.

Other affected parties: treating clinicians and medical experts will be affected in practice because the SoP lists the medical factors that are relevant to raising a reasonable hypothesis of service connection (s9). For example, proof of a heart transplant before clinical onset, documentation of chest trauma immediately preceding clinical worsening, or evidence that appropriate clinical management could not be obtained before clinical worsening will be determinative for causation under this SoP (s9; s10(2)). Insurers or third parties are not mentioned.

Geographic and temporal scope: the instrument commences on 24 November 2025 and repeals the earlier 2017 Statement (s2, s4). It applies to claims to which the specified sections of the VEA or MRCA apply, meaning it operates within the temporal and statutory limits of those Acts as they apply to individuals’ claims (s5).

The SoP establishes medical criteria and relationships but does not itself impose duties in the form of new criminal or civil obligations. Instead it sets the evidentiary and medical framework that triggers statutory rights and administrative duties under the VEA and MRCA. From the instrument’s text, the following duties and rights can be discerned.

Rights:

• A claimant whose condition meets the SoP criteria may have a reasonable hypothesis raised that cardiac myxoma or death from cardiac myxoma is connected to relevant service (s9; s10). The instrument therefore creates the precondition for a claimant to assert rights under the VEA or MRCA (s5), though the instrument does not specify the entitlements themselves.

Duties and administrative obligations (implied by application):

• Decision‑makers administrating claims under the cited statutory provisions must apply this SoP when assessing whether a reasonable hypothesis has been raised in respect of cardiac myxoma (s5, s9). The SoP directs that at least one of the listed medical factors be present (s9).

• Where a factor listed in s9 refers to an injury or disease covered by another SoP, decision‑makers must apply the factors in that other SoP as in force from time to time (s11). This imposes a duty on the decision‑maker to cross‑refer and apply updated SoPs.

Operational duties for claimants (practical, not statutory within the text):

• To rely on the SoP a claimant will need to establish the factual existence of at least one factor in s9 and that the factor is related to relevant service (s9; s10(1)). The SoP’s structure points to an evidentiary duty on claimants to produce medical and service records demonstrating those factors, though the instrument does not prescribe procedural steps.

Discretion and determinations:

• The RMA has exercised its statutory discretion to determine this SoP under subsection 196B(2) of the VEA (s3, s8). The SoP does not itself define how decision‑makers should resolve disputes of fact or weigh competing medical evidence; it establishes the medical markers that, if supported by evidence, are sufficient to raise the reasonable hypothesis.

Limitations on applicability:

• The “clinical worsening” language is restricted by s10(2). The SoP clarifies that where the myxoma was suffered or contracted before or during relevant service, but did not arise out of service, the “clinical worsening” elements in s9 only apply to material contribution to, or aggravation of, the myxoma (s10(2)). This places a limiting construction on when certain factors give rise to a reasonable hypothesis.

In sum, the SoP creates rights in the sense of setting out the medical preconditions for invoking statutory entitlements under the VEA/MRCA. It places obligations on decision‑makers to apply these preconditions and to cross‑apply other SoPs where factors reference other injuries or diseases (s11). The text itself does not create new monetary duties or procedural timelines.

The instrument is a medical‑causation Statement of Principles and contains no penal sanctions, civil penalties, or criminal offences within its text. It is not drafted to create enforcement mechanisms or penalties; rather it prescribes medical criteria to be applied in the statutory claims framework under the VEA and MRCA.

Enforcement context and implications:

• The SoP will be used by the authorities administering the VEA and MRCA to determine whether a reasonable hypothesis has been raised that the condition is related to relevant service (s5, s9). Any enforcement in the sense of granting or denying entitlements, or imposing administrative obligations under those Acts, will arise from decisions made under the VEA and MRCA, which are outside the SoP’s text.

• The instrument requires decision‑makers to apply cross‑referenced SoPs where factors in s9 refer to other injuries or diseases (s11). Failure by a decision‑maker to take the RMA’s SoP into account when assessing a relevant claim could be the subject of administrative review or judicial review under the governing statutory framework. The SoP itself does not outline review rights or remedies.

Compliance verification:

• The SoP identifies discrete factors that, if proven, raise the reasonable hypothesis (s9). Decisions about whether a factor is present will be based on medical and factual evidence. The instrument includes particular phrases that will be the focus of contested determinations, such as “immediately preceding clinical worsening” and “inability to obtain appropriate clinical management” (s9(2)-(3)). Interpretation and factual findings on these points will drive outcomes, but the SoP does not prescribe enforcement processes.

Relevance to liability or fault:

• The instrument is neutral as to fault. It focuses on causation (connection between condition and relevant service) rather than on whether any person acted negligently or unlawfully. It does not create civil causes of action or criminal liability.

In short, the RMA’s Statement of Principles is an evidentiary instrument used within statutory entitlement schemes; it contains no standalone penalties or enforcement provisions. Any enforcement consequences flow from the VEA and MRCA decision processes that apply the SoP.

The instrument explicitly situates itself within and interacts with the VEA and MRCA statutory schemes and with other Statements of Principles.

Direct statutory references:

• It is made under subsection 196B(2) of the VEA (s3) and expressly applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (s5). Those cross‑references tie the SoP directly into the statutory claims and entitlements frameworks established by the two Acts. The instrument’s operational effect is therefore limited to the contexts and persons covered by those statutory provisions.

Interaction with other Statements of Principles:

• If a factor in s9 refers to an injury or disease covered by another SoP determined under subsection 196B(2) of the VEA, the factors in that other SoP apply in accordance with that SoP as in force from time to time (s11). This creates a built‑in cross‑SoP interaction rule: the presence of an overlapping factor triggers application of the other SoP’s criteria and any subsequent amendments to that SoP.

Medical classification systems:

• The instrument cites ICD‑10‑AM coding (s7(3)): it notes that cardiac myxoma attracts ICD‑10‑AM code D15.1, and describes how references to an ICD‑10‑AM code are to be read (code assigned in the ICD‑10‑AM Tenth Edition, effective 1 July 2017). However the instrument makes clear that for the purposes of the SoP the meaning is the statutory definition in s7(2). Thus there is a nominal interaction with the national clinical classification system but the statutory definition controls application.

Overlap with other legal concepts:

• The Schedule defines “terminal event” and “relevant service”. Those definitions import and reconcile concepts used across the VEA and MRCA frameworks. For example, “relevant service” is defined to include categories from both the VEA and MRCA (Schedule). This ensures the SoP is applicable across overlapping veteran and service‑related statutory categories.

Temporal interactions:

• The instrument repeals a prior SoP (No. 32 of 2017) (s4). That means claims must be assessed under the current instrument from its commencement date (s2). Section 11’s cross‑application provision means that changes to other SoPs after this instrument’s commencement may alter how overlapping factors are applied.

What the instrument does not do:

• It does not amend the VEA or MRCA themselves, nor does it change statutory rights or obligations directly. It is a medical determination instrument that decision‑makers should apply when those Acts require a finding about causation for entitlement purposes. The SoP does not provide procedural rules for claim lodgement, merits review, or judicial review, nor does it set compensation amounts or entitlements; those remain for the parent Acts.

In practice, therefore, the SoP interacts with the VEA/MRCA in a directing and evidentiary capacity: decision‑makers using the VEA and MRCA will apply the SoP’s medical criteria and the cross‑SoP rules (s11) to decide whether the statutory causation threshold , the reasonable hypothesis , is met.

The instrument records a single explicit amendment event within its text: it repeals the earlier Statement of Principles concerning cardiac myxoma (Reasonable Hypothesis) No. 32 of 2017 (Federal Register No. F2017L00463) (s4). This instrument is itself dated 24 October 2025 and commences on 24 November 2025 (cover page and s2). No other amendments or past amendment history are recorded in the body of the text supplied.

From the instrument’s text the following temporal points are germane:

• The RMA has determined this SoP under subsection 196B(2) of the VEA (s3; cover page signature dated 24 October 2025).
• The instrument expressly repeals the 2017 SoP for cardiac myxoma (s4).
• The new SoP commences one month after the determination date (s2).

Implications of the recorded repeal:

• The repeal clause means the 2017 SoP no longer applies from the commencement date. Claims assessed from 24 November 2025 must be considered under the terms of this instrument. The instrument does not state whether any decisions made under the repealed SoP are to be revisited; that is governed by the procedural and review rules in the VEA/MRCA which are not contained in this text.

Amendment pathway and future change:

• The instrument does not itself set out an amendment mechanism, but it notes in s11 that other SoPs as in force from time to time apply where relevant. That indicates the RMA expects SoPs to be updated and to operate dynamically across medical areas. Any future amendments to this SoP would be effected by the RMA under the same statutory power (subsection 196B(2) of the VEA), but no such amendments are recorded here.

What is absent:

• There is no express transitional provision in the instrument dealing with claims in progress at the date of repeal or commencement. The instrument likewise does not record prior amendment chronology beyond the explicit repeal of the 2017 instrument. The only recorded change is the replacement of the earlier SoP with this new instrument.

Users of the SoP should therefore treat the instrument as the operative statement from 24 November 2025 and, where overlap with other SoPs exists, apply those other SoPs as amended from time to time (s11). Any historical analysis of how causal thresholds differed between the 2017 and 2025 instruments would require comparison with the text of the repealed 2017 instrument, which is not provided here.

The instrument itself does not contain a litigation history and does not cite any judicial decisions. The RMA records its view that there is sound medical‑scientific evidence linking cardiac myxoma and death from cardiac myxoma to relevant service (s8), but it does not record or summarise any case law or administrative determinations that have tested the SoP in courts or tribunals.

Consequently, within the confines of the text provided:

• There are no named cases, appeal outcomes, or judicial interpretations included or referenced.
• There is no administrative decisions history attached to this instrument.

Areas likely to generate litigation or review (textual indicators):

• Interpretation of the “reasonable hypothesis” threshold. The instrument repeatedly frames its function in terms of raising a reasonable hypothesis that cardiac myxoma is connected to relevant service (title and s9). While the instrument establishes the medical factors sufficient to raise that hypothesis, disputes could arise over whether the factual record supports the existence of those factors in an individual case. The text provides no procedural guidance on resolving such disputes.

• Meaning of temporal qualifiers and medical phrases. The instrument contains language that invites contested interpretation, for example: “immediately preceding clinical worsening” (s9(2)), “inability to obtain appropriate clinical management for cardiac myxoma before clinical worsening” (s9(3)), and the application limitation in s10(2) regarding conditions suffered or contracted before or during service but not arising out of service. Claims or reviews may centre on the factual application of these phrases to specific medical histories.

• Cross‑SoP interaction. Where s9 factors reference other injuries or diseases for which an SoP exists, s11 requires application of those other SoPs “as in force from time to time”. Litigation or review may arise if there is an inconsistency between SoPs or if an amendment to another SoP changes how overlapping factors should be applied.

What the instrument does not permit readers to infer:

• The text does not identify any prior litigation outcomes that informed the RMA’s determination. It does not provide administrative decisions or judicial reasoning as the basis for any particular wording. Any judicial commentary relevant to the instrument would need to be sourced outside the present text.

In summary, no litigation history is recorded in the instrument. The document’s phrasing and the technical elements it introduces set out points that could be the subject of administrative review or judicial challenge in practice, but no such cases are cited or summarised in the text provided.

This instrument contains several specific drafting and evidentiary features that practitioners should note because they have practical consequences for claim formulation, evidence gathering, and dispute risk.

1. Narrow, enumerated factors as sufficiency criteria (s9)

• The instrument requires at least one of the three listed factors to exist in order to raise a reasonable hypothesis (s9). The list is short and discrete: heart transplant before clinical onset (s9(1)), blunt force chest trauma immediately preceding clinical worsening (s9(2)), and inability to obtain appropriate clinical management before clinical worsening (s9(3)). If a claimant cannot show one of these factors, the SoP does not, on its face, provide an alternate pathway to raise a reasonable hypothesis. Practically this focuses evidence collection on satisfying one of those enumerated markers.

2. Tense and sequencing issues: “before clinical onset” and “immediately preceding clinical worsening”

• The phrase “having a heart transplant before clinical onset” (s9(1)) is potentially counter‑intuitive and will require careful factual pleading. It mandates a transplant occurred prior to the clinical onset of cardiac myxoma. That ordering may be uncommon and will need explicit documentary proof.
• “Immediately preceding clinical worsening” (s9(2)) invites tight temporal proof. What constitutes “immediately” is not defined; claimants will need to deploy contemporaneous medical records and expert evidence to tie blunt force chest trauma to a proximate clinical deterioration.

3. “Inability to obtain appropriate clinical management” is indeterminate (s9(3))

• The phrase “inability to obtain appropriate clinical management for cardiac myxoma before clinical worsening” raises questions about what is “appropriate”, who assesses appropriateness, and whether causation is established by the inability alone or requires linking that inability to clinical worsening. The SoP does not supply objective thresholds or examples for “appropriate clinical management”. Practitioners should anticipate contested expert evidence on standards of care and accessibility.

4. Relationship to relevant service is required (s10(1))

• Any factor relied upon must be related to the person’s relevant service (s10(1)). The Schedule’s definition of relevant service lists multiple categories under VEA and MRCA (Schedule). Establishing such a relationship will generally require service records or contemporaneous incident reports.

5. Limitation where myxoma was suffered or contracted before/during service but did not arise out of service (s10(2))

• The instrument narrows the application of “clinical worsening” factors to cases where the myxoma was suffered/contracted before or during, but did not arise out of, relevant service (s10(2)). That wording requires careful case framing: if the myxoma arose out of service, the clinical worsening formulation in s10(2) does not apply. Practitioners should analyse timing and origin questions closely.

6. Cross‑SoP dependency (s11)

• If a s9 factor references an injury or disease covered by another SoP, the factors in that other SoP apply (s11). This means proof of certain causal pathways may require consulting and applying separate SoPs as in force from time to time, including any later amendments. There is a risk of circularity or changed legal outcomes if another SoP is amended after a claimant has lodged a claim.

7. ICD‑10‑AM code referenced but not determinative (s7(3))

• The instrument notes cardiac myxoma attracts ICD‑10‑AM code D15.1 but states the statutory definition controls for application of the SoP (s7(2)-(3)). Practitioners should include but not rely solely on coded diagnoses; contemporaneous clinical descriptions matching the statutory definition will be necessary.

8. Death inclusion is broader than direct cause of death (s7(4); Schedule)

• Death from cardiac myxoma includes death from a terminal event or condition that was contributed to by the cardiac myxoma (s7(4)). The Schedule lists representative terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). Claims involving death may therefore require medical evidence demonstrating contribution rather than exclusive causal primacy.

9. No procedural guidance or transitional provisions

• The instrument contains no guidance on evidentiary standards, timing, or transitional arrangements for claims in progress at commencement (s2, s4). Practitioners must look to the VEA/MRCA and administrative practice for procedural mechanics.

10. Repeal of the 2017 SoP (s4)

• The 2017 SoP is repealed. Differences between that prior instrument and the 2025 SoP may materially affect pending or future claims; practitioners should compare texts where relevant.

These features mean that claimants and advisors must be precise about chronology, produce robust contemporaneous medical and service evidence, and anticipate contested expert opinion on standards of care and temporal causation.

Compliance in the context of this SoP means assembling and presenting the factual and medical evidence necessary to demonstrate that at least one of the enumerated factors in section 9 exists and that the factor is related to the person’s relevant service (s9; s10(1)). The SoP itself does not prescribe steps for lodgement or procedural timelines; those are governed by the VEA and MRCA. The following practical actions flow directly from the instrument’s text and are designed to match the SoP’s requirements.

1. Establish the medical diagnosis in statutory terms (s7(2)-(3))

• Obtain clinical records that identify the condition as cardiac myxoma and that document histological, imaging, surgical, or specialist cardiology findings consistent with the statutory definition: “a benign neoplasm of the heart composed of primitive connective tissue cells and stroma resembling mesenchyme” (s7(2)). While ICD‑10‑AM coding is informative, ensure the record supports the SoP’s textual definition (s7(3)).

2. Prove one of the s9 factors

• Heart transplant before clinical onset (s9(1)): Provide transplant surgery records, pre‑ and post‑operative notes, and clinic correspondence establishing dates of transplant and dates of clinical onset of cardiac myxoma. The SoP requires the transplant to have occurred before clinical onset; documentation must make that chronology clear.

• Blunt force trauma to the chest immediately preceding clinical worsening (s9(2)): Assemble incident reports, service records, emergency department records, imaging studies, and contemporaneous clinician notes that document chest trauma and then demonstrate clinical worsening attributable to myxoma (for example embolic events, infarctions, or sudden deterioration). The temporal proximity implied by “immediately preceding” points to contemporaneous documentation as decisive.

• Inability to obtain appropriate clinical management before clinical worsening (s9(3)): Collect records showing attempts to access care, referrals, transfer requests, or deferred treatments, and evidence of the resulting clinical deterioration. Documentation should address what clinical management was indicated, why it was not obtained, and how that lack of management materially preceded clinical worsening. Be prepared to support assertions about “appropriateness” with expert opinion attesting to standard of care and the impact of delays or denial of care.

3. Connect the factor to relevant service (s10(1); Schedule)

• Produce service records, incident reports, deployment logs, medical evacuation records, and any contemporaneous military clinical notes linking the event or the inability to obtain care to the period or circumstances of relevant service as defined in the Schedule (operational, peacekeeping, hazardous, British nuclear test defence service under VEA; warlike/non‑warlike under MRCA).

4. Where the myxoma preceded service or was contracted before or during service but did not arise out of service, focus on clinical worsening (s10(2))

• If the cardiac myxoma pre‑existed service, assemble evidence specifying the timing and details of clinical worsening and show how the factor relied upon materially contributed to aggravation. The SoP limits application of the clinical worsening elements to material contribution or aggravation in these circumstances (s10(2)).

5. Anticipate cross‑SoP applications (s11)

• If any s9 factor references another disease or injury for which an SoP exists, identify that SoP and gather evidence required under it because s11 directs application of that SoP’s factors “as in force from time to time.” This may require up‑to‑date review of other SoPs and their evidentiary thresholds.

6. Address death‑related claims with contribution evidence (s7(4); Schedule)

• For death claims, assemble the decedent’s terminal care records, cause of death certificate, autopsy or post‑mortem reports, and expert opinions that explain how the cardiac myxoma contributed to the terminal event (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) as defined in the Schedule.

7. Prepare for expert evidence and contested interpretation

• Expect disputes over terms like “immediately”, “appropriate clinical management”, and the causal link between a factor and clinical worsening. Engage clinicians with relevant specialty expertise to provide opinions tied expressly to the statutory language in the SoP.

8. Document chronology and causal pathways precisely

• The SoP’s operation depends on temporal sequencing (transplant before onset, trauma before clinical worsening, management inability before clinical worsening). Build a clear timeline with date‑stamped records to reduce interpretive ambiguity.

9. Consider procedural pathways under VEA/MRCA

• The SoP applies to claims under section 120A of the VEA and section 338 of the MRCA (s5). Practitioners should ensure procedural compliance with claim lodgement, evidence submission, and review rights governed by those Acts. The SoP does not provide procedural guidance, so use the parent Acts’ processes.

10. Monitor other SoPs and SoP amendments

• Because s11 imports other SoPs “as in force from time to time”, keep abreast of amendments to related SoPs that might change evidentiary requirements for overlapping factors.

In practical terms, compliance is evidence management tailored to the SoP’s tight list of factors, careful chronological proof, and targeted expert opinion that maps medical facts onto the statutory language. The SoP gives a small number of routes to raise a reasonable hypothesis; matching your evidence to those routes is the essential compliance task.