Statement of Principles concerning clonorchiasis (Reasonable Hypothesis) (No. 25 of 2025)

The document builds around a handful of tightly delimited legal and medical concepts that will be used for adjudicating claims.

Clonorchiasis, as defined here, is an infestation of the biliary system by the trematode Clonorchis sinensis (section 7(1)). Although the ICD‑10‑AM code B66.1 is noted as assigned to clonorchiasis, the instrument makes clear that, for application of the Statement, the meaning provided in the instrument controls (section 7(2) and (3)). That preserves the Authority’s textual diagnostic definition over reliance on coding alone.

Death from clonorchiasis is not automatic on the diagnosis of clonorchiasis. The Statement defines it as death from a terminal event or condition that was contributed to by the person’s clonorchiasis (section 7(4)). The Schedule provides a non-exhaustive list of what counts as a terminal event, including pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (Schedule - terminal event). The legal effect is that claimants and decision-makers must establish a contribution by clonorchiasis to one of these proximate or ultimate causes to treat a death as death from clonorchiasis under this Statement.

The “reasonable hypothesis” threshold is central but not restated from the VEA in this instrument. Instead, the instrument lists the factors that must exist “as a minimum” before a reasonable hypothesis can be said to be raised (section 9). Those factors are factual triggers, not prescriptive treatment protocols. They are:

• Ingesting skin or flesh of raw, undercooked, iced, pickled, or smoked freshwater fish at least three weeks before clinical onset (section 9(1)). The instrument adds a note identifying countries where clonorchiasis is endemic including China, Korea, Russia, Taiwan and Vietnam, which is guidance rather than a definitional limit.
• Inability to obtain appropriate clinical management for clonorchiasis before clinical worsening (section 9(2)).

Section 10 imposes relational limits. Every factor relied upon must be related to the person’s relevant service (section 10(1)). The clinical-management factor in section 9(2) is expressly limited to situations where the person’s clonorchiasis was suffered or contracted before or during, but did not arise out of, the relevant service; in such cases inability to obtain appropriate clinical management can materially contribute to or aggravate clonorchiasis (section 10(2)). That confines the second factor to aggravation or material contribution of pre-existing or contemporaneous but non-service arising disease.

Section 11 sets the interaction rule with other Statements of Principles: if a factor in this Statement refers to an injury or disease already governed by another Statement, then the factors in that other Statement apply in accordance with their terms as in force from time to time (section 11). The Schedule defines “relevant service” across VEA and MRCA categories such as operational service, peacekeeping, hazardous service, British nuclear test defence service, warlike and non-warlike MRCA service (Schedule - relevant service).

Collectively, these concepts convert clinical facts and certain service‑related circumstances into the minimum factual predicates that raise a legally relevant hypothesis for claims processing under the VEA and MRCA.

This Statement primarily affects persons making claims under the VEA or the MRCA for clonorchiasis or death from clonorchiasis. Section 5 states the instrument applies to a claim to which section 120A of the VEA or section 338 of the MRCA applies. Therefore, claimants whose claims fall within those provisions are directly affected because the Statement sets the factual features that will, legally, be treated as sufficient to raise a reasonable hypothesis linking disease or death to relevant service (sections 5 and 9).

The instrument also affects the administrative and clinical actors who prepare, examine and decide claims. The Repatriation Medical Authority (RMA) issues the Statement (section 3). Decision-makers under the VEA and MRCA who assess claims will apply the Statement’s listed factors as the threshold for a reasonable hypothesis. Medical practitioners who supply opinions and GPs or specialists who treat veterans will be affected in practice because evidence they provide must engage the factors set out at section 9 to help meet the reasonable hypothesis threshold. Clinical coders and record-keepers will be affected by the instrument’s note about ICD‑10‑AM code B66.1 being associated with clonorchiasis, although the instrument stresses the textual definition controls (section 7(2) and (3)).

Service organisations, advocates and legal advisers preparing claims will need to collect evidence that directly addresses the instrument’s factors: for example, contemporaneous travel and dietary history to show ingestion of freshwater fish prepared in the specified ways at least three weeks before clinical onset (section 9(1)), medical records showing diagnosis and timing, and records demonstrating inability to obtain appropriate clinical management before clinical worsening where section 9(2) is relied upon and where the limitation in section 10(2) is engaged.

Deaths are affected if the death involved a terminal event that clonorchiasis contributed to (section 7(4) and Schedule - terminal event). Families and legal representatives lodging death-related claims will need to evidence both the underlying clonorchiasis and its contribution to the terminal event specified.

Finally, the instrument implicates overlapping Statements of Principles. Where a factor in this Statement refers to an injury or disease governed by another Statement made under subsection 196B(2) of the VEA, then that other Statement’s factors apply (section 11). That creates an administrative interface affecting how multiple Statements are applied together in composite claims.

The instrument does not itself change statutory entitlements, prescribe payments, or set penalties; it modifies the evidentiary landscape for adjudication of claims under existing entitlement statutes by stipulating the factual predicates that would give rise to a reasonable hypothesis connecting clonorchiasis with relevant service.

This instrument does not create novel criminal or civil duties; instead, it prescribes the minimum factual criteria that must be present for a reasonable hypothesis to be said to exist, which in turn informs rights under the VEA and MRCA. The key legal effects flow through three categories: decision-maker duties, claimant evidentiary responsibilities, and the derivative right to have a matter proceed to entitlement consideration if the reasonable hypothesis threshold is met.

Decision-makers under the VEA and MRCA will be required, as a matter of administrative law practice, to treat the factors in this Statement as the baseline for assessing whether a reasonable hypothesis exists that links clonorchiasis or death from clonorchiasis to relevant service (section 9). Although the instrument does not on its face specify an administrative duty, its legal function is to guide adjudicators. The RMA has declared the scientific basis for the Statement (section 8), and the instrument is intended to be applied by those administering sections 120A (VEA) or 338 (MRCA) claims (section 5). Practically, decision-makers must assess whether at least one of the listed factors exists and whether it is related to the person’s relevant service (section 10(1)). If the clinical-management factor at section 9(2) is relied upon, adjudicators must also apply the limitation in section 10(2) and determine whether the clonorchiasis was suffered or contracted before or during, but did not arise out of, relevant service.

Claimants have an evidentiary duty to produce, or facilitate the collection of, evidence that engages the relevant factor(s). For example, a claimant relying on section 9(1) must provide evidence of ingestion of freshwater fish in the specified preparations at least three weeks before clinical onset. A claimant relying on section 9(2) must provide evidence that appropriate clinical management could not be obtained before clinical worsening. The Statement’s framing as setting "factors that must exist" makes these elements de facto required evidentiary components for the reasonable hypothesis threshold.

There is a derivative right implicit in the instrument. If a claimant establishes at least one of the factors in section 9, related to relevant service, then a reasonable hypothesis will be raised and the claimant will attain the procedural right to have the claim proceed to further consideration under the VEA or MRCA entitlement processes. The instrument does not itself create entitlements, but it is the RMA’s authoritative statement of the clinical-service connection required to trigger further entitlement assessment.

Where a factor in this Statement cross-refers to an injury or disease governed by another Statement determined under subsection 196B(2) of the VEA, the other Statement applies in accordance with its terms (section 11). This creates a procedural duty on both claimants and decision-makers to identify overlapping Statements and apply their factors consistently.

Finally, the Schedule’s definitions determine who falls within the instrument’s scope. The Schedule defines "relevant service" expansively across VEA and MRCA categories and defines "terminal event" for death claims. That narrows or expands applicable claims depending on the class of service undertaken by the person. Those definitions are not rights or duties in themselves, but they determine whether the Statement applies to a particular claim (Schedule - relevant service; Schedule - terminal event).

The Statement contains no express criminal penalties, regulatory fines, or direct enforcement measures. It is an evidentiary instrument issued by the Repatriation Medical Authority under subsection 196B(2) of the VEA (section 3) and does not itself establish punitive provisions. The instrument’s operative function is to prescribe the factual elements required to raise a reasonable hypothesis linking clonorchiasis or death from clonorchiasis to relevant service; enforcement of those evidentiary rules occurs within the established administrative claim processes under the VEA or MRCA.

Practically, the instrument will be enforced through claim adjudication. Decision-makers deciding whether a claimant has raised a reasonable hypothesis will apply the factors in section 9 and the relational rules in section 10. The statutory entitlement processes under the VEA and the MRCA contain their own compliance, review and potential sanction mechanisms, but those are outside the four corners of this instrument; the Statement is a tool used in those processes rather than a vehicle for standalone enforcement. Section 5 makes clear the Statement applies to claims to which s120A VEA or s338 MRCA apply. Any consequences for failure to establish a factor, or to provide evidence, will be procedural: the claim may fail to meet the reasonable hypothesis threshold and thus not proceed to a merits determination of entitlement.

The instrument also creates a potential administrative obligation on decision-makers to consult other Statements. Section 11 states that where a factor in this Statement refers to an injury or disease covered by another Statement, the factors in that other Statement apply according to their terms. That imposes an enforcement-like duty on adjudicators to identify and apply the correct cross-references.

Because the Statement places emphasis on clinical timing, causation and contribution to death, disputes may arise over evidentiary sufficiency. The instrument does not specify review rights, appeal routes, or timeframes; those remain governed by the VEA, the MRCA and their administrative review and appeal mechanisms. The absence of penalty provisions in this Statement means that enforcement is procedural and adjudicative rather than punitive.

The Statement is explicitly framed as an instrument made under subsection 196B(2) of the Veterans' Entitlements Act 1986 (section 3). It applies to claims under the VEA and MRCA by reference to section 5, which specifies application to claims to which section 120A of the VEA or section 338 of the MRCA apply. That creates a direct, procedural interaction: the Statement is authoritative guidance for adjudicators when applying statutory claims provisions in those Acts.

Section 7(3) cross‑references the ICD‑10‑AM coding system , The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (Tenth Edition, effective 1 July 2017) , but the instrument disclaims that the legal meaning for the purposes of the Statement is the textual definition supplied in subsection 7(2). Thus, while clinical codification may be informative and will generally align with B66.1, the Statement controls the definitional meaning in law (section 7(2)-(3)). The net effect is that clinical coding interacts with, but does not displace, the instrument’s textual definition when the Statement is applied in statutory claim processes.

Section 11 creates direct cross-instrument interaction. If a factor in this Statement refers to an injury or disease in respect of which another Statement of Principles has been determined under subsection 196B(2) of the VEA, then the factors in that other Statement apply "in accordance with the terms of that Statement of Principles as in force from time to time" (section 11). This provision requires administrative actors to map overlapping medical issues to the current versions of other Statements. Claims involving multiple conditions will therefore require coordination among Statements and can bring in the content and timing rules of other RMA determinations.

The Schedule defines "relevant service" by reference to specific types of service under both the VEA and MRCA, including operational, peacekeeping, hazardous, British nuclear test defence service, and warlike and non-warlike service (Schedule - relevant service). That definition determines the subset of people whose claims under those statutes are affected by the Statement. Consequently, the Statement interacts with the statutory definitions and thresholds in the VEA and MRCA that determine whether particular service qualifies as relevant service under those Acts.

The Statement replaces the earlier clonorchiasis Statement (No. 47 of 2016) by express repeal (section 4). That means decision-makers must apply this Statement from its commencement date (25 March 2025) forward. Any claims or administrative decisions that rely on the RMA’s current medical view must use the 2025 Statement rather than the 2016 Statement for cases falling after commencement.

Finally, the Statement’s treatment of death as death from a terminal event contributed to by clonorchiasis (section 7(4) and Schedule - terminal event) intersects with coroner’s findings, death certificates and medical cause-of-death reporting. Although the instrument does not regulate those instruments directly, adjudicators will need to evaluate such documents in the light of the Statement’s requirement that clonorchiasis contribute to the terminal event for death to be treated as death from clonorchiasis within the claims process.

In summary, the Statement operates as an interpretive and evidentiary bridge between clinical diagnosis and statutory entitlement under the VEA and MRCA, and it requires coordination with other Statements, ICD coding practices, and the definitions of relevant service in the underlying statutes.

The Statement itself records a single explicit amendment event: it repeals the earlier Statement of Principles concerning clonorchiasis (Reasonable Hypothesis) (No. 47 of 2016) (Federal Register of Legislation No. F2016L00561) (section 4). The instrument is dated 18 February 2025 and commences on 25 March 2025 (front matter and section 2). No other amendments, transitional provisions, or savings clauses are included in the text provided.

Because this instrument replaces the 2016 Statement, decision-makers and practitioners should note that the 2016 instrument is no longer in force from the commencement date and that the 2025 Statement is the operative RMA finding for clonorchiasis from that date (section 4). The instrument contains no express transitional language addressing claims initiated before commencement; therefore, the ordinary legal approach is to treat the Statement as the operative medical finding for claims to which sections 120A (VEA) or 338 (MRCA) are applied from the commencement date forward, subject to whatever transitional decision-making frameworks exist in the administering statutes or policy guidance outside this instrument.

No subordinate amendments to the Schedule, definitions, or the factors listed in section 9 are recorded in the instrument. The Schedule provides the definitions that are part of the Statement at the time of commencement, including the list of relevant service categories and the definition of terminal event. No schedule amendments, expiry, or review date are contained in the instrument as presented.

Practitioners should be attentive to the RMA’s ongoing powers to issue, review and amend Statements under subsection 196B(2) of the VEA. Section 11 contemplates that other Statements of Principles may change “from time to time” and directs that such Statements, when relevant, apply in accordance with their terms as in force from time to time. That language signals that cross-referenced Statements may be amended independently of this instrument, potentially changing how overlapping factors interact. The instrument itself, however, records only the 2025 replacement of the 2016 Statement and provides its operative definitions and factors without further amendment history.

The text of this Statement contains no references to judicial consideration, appeals or litigation relating to either the 2025 Statement or the earlier 2016 Statement. It does not list cases, judicial interpretations or administrative review outcomes. There is no litigation history recorded in the instrument.

Because the Statement is an administrative medical instrument under subsection 196B(2) of the VEA (section 3), it is possible in principle for legal challenges to arise concerning the application of the Statement in individual claims or the RMA’s exercise of its functions, but the instrument provides no instances of such litigation. Users must therefore treat the Statement as an administrative policy document that has not, in the text supplied, been the subject of cited court decisions or published appeals.

For practitioners preparing claims or advising clients, the absence of litigation references in this instrument means there is no precedent material contained within the Statement itself to guide arguments about contested interpretation of its factors or their application. Any litigation history relevant to clonorchiasis claims would need to be identified from external sources, tribunal or court records, and administrative decisions under the VEA and MRCA. The Statement makes clear that it replaces the 2016 instrument (section 4), so any litigation that referenced the earlier Statement would need to be analysed against the new wording where applicable. The instrument itself provides no guidance on whether or how prior cases, if any, should be treated in light of the replacement.

Several drafting features of the Statement can create unforeseen evidentiary or procedural difficulties in claims processing. These are the concrete points to watch for when preparing or adjudicating claims.

Narrowly specified ingestion factor. Section 9(1) requires ingestion of the skin or flesh of freshwater fish prepared in a limited set of ways: raw, undercooked, iced, pickled, or smoked, and it requires that ingestion be at least three weeks before clinical onset. That is a tight factual requirement. Claims that involve other types of fish (for example, marine fish), other preparation methods, or uncertain timing relative to symptom onset may struggle to meet the minimum factor. The instrument includes a note listing endemic countries (China, Korea, Russia, Taiwan, Vietnam), but this is guidance and not a definitional limit (section 9(1) Note). Practitioners must therefore ensure dietary and travel histories precisely map onto the wording at section 9(1).

Temporal link requirement. The three‑week minimum interval between ingestion and clinical onset is a fixed timing criterion. Cases with ambiguous or mixed timelines could fail to engage section 9(1). The Statement supplies no alternative timelines or clinical exceptions.

Undefined terms open administrative discretion. Key phrases such as "appropriate clinical management" and "clinical worsening" in section 9(2) are not defined in the instrument. Adjudicators will therefore have to determine, in each claim, what constitutes appropriate management and what amounts to clinical worsening. That discretion creates uncertainty for claimants and may increase procedural disputes. Section 10(2) further restricts section 9(2) to material contribution to, or aggravation of, clonorchiasis where the condition was suffered or contracted before or during, but did not arise out of, relevant service. Determining whether clonorchiasis “arose out of” service will be a contested factual and legal issue in some cases.

Limited scope for clinical‑management factor. Section 10(2) narrows the clinical-management factor in section 9(2) to pre-existing or contemporaneous conditions that did not arise out of service. That means that inability to obtain appropriate clinical management cannot be invoked to establish that service caused a clonorchiasis that arose out of service. It is instead framed as a mechanism of aggravation or material contribution to a pre-existing condition. Claimants who argue that service conditions caused initial contraction of clonorchiasis cannot rely on section 9(2) to bridge causation.

Death claims require contributory evidence. Death is treated as death from clonorchiasis only where clonorchiasis contributed to a terminal event or condition (section 7(4)). The Schedule lists examples of terminal events such as pneumonia and cardiac arrest. Claimants must show that clonorchiasis materially contributed to such an event; a death where clonorchiasis is present but not shown to have made a contribution will not fall within the Statement’s definition. The instrument does not provide a standard of contribution, leaving decision-makers to assess contribution on the available evidence.

ICD‑10‑AM coding is informative but not determinative. Section 7(2) and (3) clarify that while clonorchiasis attracts ICD‑10‑AM code B66.1, the legal meaning in this Statement is the textual definition in subsection 7(2). Reliance on coding alone without showing the defined infestation of the biliary system by Clonorchis sinensis could be insufficient.

Cross-references to other Statements may complicate claims. Section 11 requires that where a factor in this Statement refers to an injury or disease covered by another Statement, the factors in that other Statement apply "as in force from time to time". Practitioners should therefore verify whether overlapping factors draw in other current Statements and whether those Statements have differing thresholds or definitions that affect the claim.

Relevance of "relevant service." The Schedule’s definition of relevant service includes several categories across the VEA and MRCA. The Statement applies only where the claimant’s service meets one of those categories. Claims where service does not fall within the Schedule’s definition will not be able to rely on this Statement.

No transitional provisions. The repeal of the 2016 Statement (section 4) is not accompanied by transitional rules in the instrument. Where claims straddle the repeal date, practitioners should be alert to administrative guidance or statutory rules outside the Statement that determine which Statement applies.

In short, narrow factual triggers, undefined clinical terms, temporal constraints, the limitation on the clinical-management factor, and cross-references to other Statements are the principal “gotchas” that can cause otherwise plausible claims to fail the reasonable hypothesis threshold if not carefully documented.

This Statement defines the factual minimums that must be established to raise a reasonable hypothesis connecting clonorchiasis or death from clonorchiasis to relevant service. Compliance for claimants and their advisers therefore focuses on assembling evidence that directly maps to the instrument’s elements and on anticipating the instrument’s relational and definitional constraints.

1. Identify whether the claim falls within the Statement’s application. Confirm the claim is a claim to which section 120A of the VEA or section 338 of the MRCA applies (section 5) and that the person’s service falls within the Schedule’s definition of relevant service (Schedule - relevant service). If relevant service is not established under those definitions, the Statement will not apply.

2. Choose which factor in section 9 will be relied upon. At least one of the factors in section 9 must be established. For most primary claims, the ingestion factor in section 9(1) will be relied upon. For claims of aggravation or material contribution where clonorchiasis pre-existed or was contracted during service but did not arise out of service, the clinical-management factor in section 9(2) may be relevant. Keep in mind section 10(2) limits use of section 9(2) to those pre-existing or contemporaneous but non-service arising conditions.

3. Build documentary evidence for the ingestion factor (section 9(1)). Evidence should demonstrate:

   • The person ingested skin or flesh of freshwater fish prepared as raw, undercooked, iced, pickled or smoked.
   • The timing of ingestion was at least three weeks before clinical onset. Establishing symptom onset dates and corroborating dietary histories is therefore essential.
   • If relevant, proof of travel to or residence in endemic areas may be useful background evidence. The Statement includes a note listing endemic countries (China, Korea, Russia, Taiwan, Vietnam), which may help contextualise exposure, but the core requirement remains the factual demonstration of the ingestion and the timing.

4. Compile medical records that document diagnosis and onset. Provide clinical notes, laboratory results, diagnostic imaging, pathology reports and coding (ICD‑10‑AM B66.1 where present) that confirm clonorchiasis consistent with the instrument’s textual definition of infestation of the biliary system by Clonorchis sinensis (section 7(1) and (2)). While coding is supportive, the textual medical diagnosis is determinative (section 7(3)).

5. Where relying on section 9(2), document inability to obtain appropriate clinical management and clinical worsening. Evidence should show attempts to obtain appropriate care and barriers encountered (for example, contemporaneous service medical logs, referral delays, lack of access to specialist treatment, records of unavailability, or other contemporaneous documentation). Demonstrate that inability to obtain care occurred before clinical worsening and that the worsening is documented. Also ensure that the clonorchiasis was suffered or contracted before or during service but did not arise out of service, because section 10(2) confines the operation of section 9(2) to such situations.

6. For death claims, document contribution to a terminal event. Assemble death certificates, medical cause of death statements, hospital records, and any coroner’s findings that identify terminal events listed in the Schedule (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) and evidence linking clonorchiasis as a contributing factor to that terminal event (section 7(4); Schedule - terminal event).

7. Address cross-referenced Statements where applicable. If a factor refers to another disease or injury subject to a different Statement, obtain and rely on the factors specified in that other Statement as those factors are “in force from time to time” (section 11). This may require gathering additional evidence specified in the other Statement.

8. Prepare a clear chronological narrative tying exposure, diagnosis and service. Because the reasonable hypothesis threshold in this instrument depends on timing and relationship to service (section 10), provide a succinct timeline that links ingestion or inability-to-treat events to clinical onset and to the period of relevant service.

9. Anticipate adjudicator scrutiny of undefined terms. Because phrases such as "appropriate clinical management" and "clinical worsening" are not defined, include contemporaneous documentation of what constituted appropriate management in the treating context, attempts or refusals to obtain it, and objective evidence of clinical deterioration.

10. When in doubt, obtain medical opinions that explicitly address the Statement’s factors. Treating clinicians and specialists should be asked to comment directly on whether, on the facts, the ingestion history satisfies section 9(1) or whether the inability to obtain management satisfied section 9(2), and whether clonorchiasis contributed to a terminal event in death cases. A medical opinion that speaks to the instrument’s language will assist adjudicators in determining whether a reasonable hypothesis has been raised.

11. Keep in mind administrative timing and the current Statement. The 2016 Statement has been repealed (section 4) and the 2025 Statement commences 25 March 2025 (section 2). Ensure claims lodged or considered from that commencement date rely on the 2025 Statement’s language.

In summary, compliance is documentary and factual. Claims succeed in raising a reasonable hypothesis only if evidence is assembled to meet the precise factual predicates in section 9 and, where required, to satisfy the relational rules in section 10 and the definitional standards in section 7 and the Schedule.