Statement of Principles concerning colorectal adenoma (Reasonable Hypothesis) (No. 15 of 2022)

The instrument is built around several central definitions and operational concepts. “Colorectal adenoma” is defined in section 7(2) as a benign neoplasm arising from the epithelial cells of the colorectum. This includes adenomatous polyp, sessile serrated adenoma, and traditional serrated adenoma. Critically, it excludes benign neoplasms of the anus and anal canal, familial adenomatous polyposis, non-neoplastic polyps of the colon (such as hyperplastic polyps), nonepithelial neoplasms (like lipomas or leiomyomas), and non-polypoid dysplasia. The exclusion of familial adenomatous polyposis is notable because that condition has a strong genetic basis and would not generally be service-related. The exclusion of non-polypoid dysplasia (flat dysplasia) reflects that it is a precursor lesion diagnosed by histology in patients with inflammatory bowel disease, which is covered by a different SOP. The instrument also gives reference to ICD-10-AM codes D12.0 to D12.8, but the meaning of colorectal adenoma is as defined, not as per the code.

“Relevant service” is defined in the Dictionary as operational service, peacekeeping service, hazardous service, or British nuclear test defence service under the VEA, or warlike or non-warlike service under the MRCA. This mimics the definition found in the VEA and MRCA and ensures consistency.

The “reasonable hypothesis” standard is not defined in this instrument but arises from the VEA itself. The SOP’s role is to provide the medical-scientific basis for determining whether a hypothesis is reasonable. The Authority states that it is of the view that there is sound medical-scientific evidence indicating that colorectal adenoma can be related to such service (section 8). This statement is a legal conclusion, not a factual finding; it is the predicate for the Authority’s power to make the SOP.

Many important concepts are defined in Schedule 1 - Dictionary. “Being overweight or obese” is defined using either a BMI of 25 or greater, or a waist circumference exceeding 94 cm for males or 80 cm for females. This allows a claimant to rely on a simpler anthropometric measure if BMI is not available. “BMI” is defined as weight in kilograms divided by height in metres squared. “Fibre in food” means complex carbohydrates of plant origin that resist digestion by gastrointestinal enzymes, including plant cell walls and non-starch polysaccharides. This definition excludes supplemental or purified fibre sources like psyllium husk, unless they come from the food matrix. “One pack-year” equals 20 cigarettes per day for one year, or an equivalent amount of tobacco products (7,300 grams of smoking tobacco). The calculation method is given in a note, offering clarification for assessment. “MET” is the unit of measurement of physical exertion: 1 MET = resting metabolic rate. “Processed meat product” means preserved or cured meats such as ham, frankfurters, salami and bacon. “Red meat” means all types of mammalian meat, including beef, veal, pork, lamb, mutton, horse and goat. Importantly, this includes pork, which is sometimes classified differently in public health advice. “Acromegaly” is defined as a chronic disease from excessive growth hormone after closure of the epiphyses, distinguishing it from gigantism in children.

“Adenoma of the colon” is a subcategory used for factors (8)(a) to (e) because those factors apply only to colon adenomas, not rectal adenomas. The colon is defined anatomically from the caecum (including ileocaecal junction and appendix) to the sigmoid colon, excluding the rectosigmoid junction. This means that if the adenoma is located in the rectum, the colon-specific factors (physical inactivity, acromegaly, red meat, processed meat, low fruit/veg) cannot be used. The significance of this distinction is that certain lifestyle factors have stronger evidence for colon than rectal sites.

The “clinical onset” of colorectal adenoma is a critical temporal concept. The factors require various durations and windows before clinical onset, but the term itself is not defined in the SOP. It will be interpreted as the time when the adenoma first becomes manifest, typically when found on colonoscopy or when symptoms occur. This creates ambiguity; a claimant with an adenoma found on screening may argue the clinical onset was at diagnosis, while the Authority might argue it was earlier based on pathological growth. The SOP leaves this to case-by-case determination.

This SOP directly affects any person who has rendered relevant service (as defined) and who claims compensation under the VEA or MRCA for colorectal adenoma or death from colorectal adenoma. That includes veterans who served in operational, peacekeeping, hazardous, or British nuclear test defence roles under the VEA, and current or former members of the Australian Defence Force who served in warlike or non-warlike service under the MRCA. The instrument does not apply to claims under the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (DRCA) for peacetime service before 1 July 2004, unless the claim is transferred or the applicable Act is amended. The scope is therefore limited to those who have rendered one of the specific types of service listed in the definition of “relevant service”.

The instrument also affects decision-makers within the Department of Veterans’ Affairs and the Military Rehabilitation and Compensation Commission, who must apply this SOP when assessing claims. It binds the Veterans’ Review Board, the Administrative Appeals Tribunal, and the Federal Court when reviewing such decisions. Legal practitioners and advocates advising veterans must understand the factors and timing requirements to frame their clients’ evidence.

In terms of economic impact, the largest burden falls on claimants who must gather historical evidence of risk factors that may date back decades. For example, proving 10 pack-years of smoking requires documentation or credible self-reporting of smoking history, with specific start and cessation dates. Proving consumption of 250 kilograms of alcohol requires reconstruction of drinking habits over many years. Proving low fibre intake or low fruit and vegetable intake for specific periods demands dietary recall that may be unreliable or impossible. The cost of obtaining such evidence - whether through medical records, family interviews, or expert reports - is borne by the individual, not the government. This creates an asymmetry: the government has no obligation to help claimants prove the factors, and an adversarial decision-maker may challenge the evidence.

The SOP also affects hospitals and pathology services that diagnose colorectal adenomas, because the classification of the lesion as within scope or outside scope matters for the claim. If a pathology report describes only “tubular adenoma” that is fine, but if it says “non-polypoid dysplasia” or “hyperplastic polyp”, the claim under this SOP will fail. The treating doctor may not be aware of the SOP definitions, so the claimant faces an additional information burden.

Finally, the SOP indirectly affects the insurance industry and taxpayers, because successful claims result in compensation payments funded by consolidated revenue or the Military Rehabilitation and Compensation Fund. By setting relatively high thresholds for many factors, the SOP acts as a cost-containment mechanism. For example, requiring at least five years of diabetes mellitus before onset excludes recently diagnosed diabetics. The alcohol threshold of 250 kg (25,000 standard drinks) is so high that it will be met only by heavy drinkers over many years, which may inadvertently penalise those with the worst habits while excluding moderate drinkers who nonetheless have an elevated risk based on the medical literature. The opportunity cost for affected individuals is the time and money spent pursuing compensation that might have been better directed elsewhere.

This SOP does not create duties or rights in the classical sense; rather, it specifies preconditions for the exercise of rights that exist under the VEA and MRCA. The right to have a claim assessed under the reasonable hypothesis standard is contingent on the claimant raising a hypothesis that is consistent with the SOP. The key duty is on the decision-maker to determine whether at least one factor in section 9 exists in the person and is related to service. If the decision-maker finds a factor present, the hypothesis is deemed reasonable and the claim moves to the next stage (which may involve the standard of reasonable satisfaction for the VEA or the MRCA’s different standards).

The claimant has the right to rely on any factor in section 9. This is a closed list; no additional factors can be considered. The only catch-all is “inability to obtain appropriate clinical management” in section 9(9), but that factor is limited by section 10(2) to “material contribution to, or aggravation of, colorectal adenoma where the person’s colorectal adenoma was suffered or contracted before or during (but did not arise out of) the person’s relevant service.” This means the factor cannot be used to establish original causation; it only applies when the adenoma existed prior to or during service but was not caused by service, and then the inability to manage it aggravated the condition. That is a narrow application.

The SOP also gives claimants the right to refer to other Statements of Principles under section 11. If a factor in section 9 refers to an injury or disease covered by another SOP (for example, if the claimant’s obesity is itself claimed as a condition, or diabetes mellitus), the factors in that other SOP apply as in force from time to time. This creates an interlocking system where multiple SOPs may be engaged, increasing complexity but also flexibility.

The duty of the Repatriation Medical Authority is to ensure that the SOP is based on sound medical-scientific evidence. This is a procedural obligation, not a substantive guarantee of correctness. The Authority’s view that the evidence supports the factors is stated in section 8, but claimants cannot challenge the SOP’s validity in a claim proceeding; they can only contest whether a factor exists.

From a property rights perspective, the SOP defines the boundaries of the entitlement. There is no right to compensation simply because a veteran has colorectal adenoma and served; the claimant must prove a specific factor and its relationship to service. This mechanism limits unfunded liabilities and preserves fiscal sustainability, but it also creates a legalised lottery depending on which factor is present and whether the claimant can prove it.

The key practical right is the right to have the claim assessed using the SOP’s definitions. If the medical evidence shows an adenoma that fits the definition, the decision-maker cannot substitute a different definition. The claimant has the right to require that the decision-maker apply the factors as written, including the note that “alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.” This is a clarification that precludes the decision-maker from using a higher standard drink measure.

This instrument does not create any penalties. It is a rule of evidence and causation for compensation claims, not a regulatory offence or civil penalty provision. Enforcement of the SOP occurs through the administrative and tribunal review system. If a decision-maker fails to apply the SOP correctly, the claimant can seek review at the Veterans’ Review Board, then the Administrative Appeals Tribunal, and ultimately the Federal Court on a question of law. The Federal Court can set aside a decision that misapplies the SOP, but cannot substitute its own view on the medical factors.

The only potential “penalty” for a claimant is the loss of compensation if they cannot satisfy the factor requirements. This is a financial consequence, but it is not a penalty imposed by the state; it is a failure to meet eligibility criteria. For the decision-maker, there are no personal penalties for incorrect application, but the department may face additional costs from reviews and appeals.

From a compliance burden perspective, the cost falls on claimants. They must gather evidence (which may involve paying for medical reports, obtaining military records, and documenting lifestyle history) without any guarantee of success. The system incentivises claimants to maximise the number of factors they attempt to prove, because only one is needed. This can lead to strategic over-documentation, increasing transaction costs.

The SOP itself does not provide for any enforcement mechanism against claimants who provide false evidence. That is handled by the general law (such as offences for making false statements under the Criminal Code or the VEA). Therefore, the SOP does not formally alter the enforcement landscape; it merely refines the substantive test.

This SOP replaces the earlier Statement of Principles concerning colorectal adenoma No. 35 of 2013 (Federal Register of Legislation No. F2013L01138). That previous instrument is repealed by section 4. The new SOP thus supplants the old one for all claims made after 31 January 2022, including claims that were pending on that date but not yet finally determined. The SOP applies to any claim to which section 120A of the VEA or section 338 of the MRCA applies (section 5). That means it applies to claims where the standard of proof is reasonable hypothesis (for VEA operational service) or reasonable satisfaction (for MRCA warlike service) - though the SOP is only directly used for the reasonable hypothesis stage. For MRCA claims, the decision-maker uses the SOP to determine whether a reasonable hypothesis is raised; thereafter the claim is decided on the balance of probabilities under the MRCA.

The SOP interacts with other Statements of Principles through section 11. If a factor in section 9 refers to an injury or disease covered by another SOP, then the factors in that other SOP apply. For example, factor 9(4) refers to “having diabetes mellitus”. Diabetes mellitus is covered by its own SOP (e.g., SOP concerning diabetes mellitus). To use factor 9(4), the claimant must satisfy the diabetes SOP’s factor requirements (such as obesity or genetic predisposition) unless diabetes was diagnosed by a doctor. But note: the factor is “having diabetes mellitus for at least 5 years before the clinical onset of colorectal adenoma”. The claimant does not need to prove that the diabetes is service-related for the purpose of this factor; they must simply have had diabetes for at least five years. However, if the claimant is trying to use the diabetes factor to also link the diabetes to service (for a separate claim), the diabetes SOP would apply. The interaction is only triggered if the factor “refers to an injury or disease” covered by another SOP. The diabetes factor simply says “having diabetes mellitus”, which is a condition, so it likely refers to that disease, meaning the diabetes SOP’s factor list could be used to establish the existence of diabetes? This is ambiguous. In practice, diabetes is usually established by medical evidence, not by another SOP. But the provision is a belt-and-braces approach.

The SOP also interacts with the companion “reasonable satisfaction” SOP that the Authority may have made for colorectal adenoma. Under s196B(1) VEA, there is a separate SOP for the reasonable satisfaction standard (balance of probabilities). That SOP would have different factors (typically narrower and requiring higher thresholds). This instrument is only for the reasonable hypothesis standard. The two SOPs must be read together: if a claim proceeds beyond the hypothesis stage, the reasonable satisfaction SOP applies. The text of this SOP does not reference that, but the statutory framework does.

The SOP may also interact with the Social Security Act 1991 if the claimant also receives disability support pension, but there is no direct interaction in this instrument. The SOP is irrelevant to civilian treatment of colorectal adenoma; it only affects veterans’ compensation.

The use of ICD-10-AM coding (section 7(4)) ties the meaning to the Tenth Edition effective 1 July 2017. If future editions are published, they are not adopted unless the SOP is amended. This potentially creates a disconnect if clinical classification changes.

This instrument itself is an amendment: it repeals and replaces the Statement of Principles concerning colorectal adenoma No. 35 of 2013. The previous SOP had likely been in force for nine years. The new SOP brings updated medical-scientific evidence regarding risk factors. The commencement date is 31 January 2022, which is unusual as it was made on 24 December 2021, so a one-month gap.

There is no further amendment history within this instrument. The SOP will remain in force until it is either repealed by a later instrument or amended. Statements of Principles are legislative instruments subject to review by the Parliamentary Joint Committee on Human Rights and are disallowable under the Legislation Act 2003. However, the Authority is an independent body, and disallowance is extremely rare.

The repeal of the 2013 SOP means that any claim that was relying on that earlier SOP will need to be assessed under the new definitions and factors. This may be detrimental to some claimants if factors were easier to meet under the old SOP. For example, if the old SOP had lower thresholds for smoking or alcohol, claimants who had already lodged claims but not yet determined could lose out because the new SOP applies to claims made after commencement, including claims that were pending? Section 5 says the instrument applies to a claim to which s120A or s338 applies. The transitional provisions are not in this instrument; they would be in the VEA or MRCA. Typically, the new SOP applies to claims not yet determined. So a claimant who had lodged a claim in 2021 but was not determined by 31 Jan 2022 would be assessed under the new SOP. This creates a risk for claimants in the pipeline. The Authority should have considered this, but the instrument is silent.

The amendment history reveals that the Authority regularly updates SOPs as new medical evidence emerges. This is a positive feature from an evidence-based perspective, but it introduces uncertainty for veterans and their representatives, who must constantly track which version applies. The instrument does not include a savings provision for claims made before commencement, which is a notable omission. That is likely handled by the enabling Act, but it adds complexity.

The instrument itself contains no reference to any litigation history. The previous SOP No. 35 of 2013 may have been considered in decisions of the Administrative Appeals Tribunal or the Federal Court, but those cases are not cited. Because we cannot invent case law, we must state only what is in the source: there is no litigation history provided.

However, it is common for Statements of Principles to be challenged on the ground that they are not based on sound medical-scientific evidence. The Federal Court has jurisdiction to review the validity of SOPs under the Administrative Decisions (Judicial Review) Act 1977 or under the jurisdiction of the High Court for constitutional matters. The user should be aware that litigation over SOPs is rare because the Authority has broad discretion. But we cannot comment further without source.

The SOP also does not mention any compensation claim litigation involving colorectal adenoma itself. Claimants who disagree with a decision may appeal to the Veterans’ Review Board and then the AAT. Those decisions are published but not cited here.

From a free-market perspective, the lack of transparency about how the factors were chosen leaves room for rent-seeking by the Authority, which has monopoly power over the SOP content. Litigation would be the only check, but its rarity suggests claimants rarely challenge the SOP itself.

Several subtle traps exist for the unwary. First, the definition of colorectal adenoma excludes non-polypoid dysplasia. A claimant with inflammatory bowel disease who develops flat dysplasia (non-polypoid) cannot use this SOP at all; they must rely on the SOP for colorectal cancer or another condition. Similarly, hyperplastic polyps are excluded. A pathology report that simply says “polyp” is insufficient; the histology must show a benign neoplasm of epithelial origin. If the report says “tubular adenoma” it is covered; if “sessile serrated adenoma” it is covered; but “sessile serrated polyp without dysplasia” may be excluded - careful analysis is needed.

Second, the timing windows are strict. For smoking, the onset must occur within 30 years of cessation. If a veteran quit 31 years before the adenoma was found, the factor fails even if the pack-year amount is huge. For alcohol, there is no window after cessation; the 250 kg must be consumed before onset, but there is no limit on how long before. So heavy drinking many decades prior may still count.

Third, the fibre factor uses “inability to consume an average of at least 20 grams per day of fibre in food”. The word “inability” suggests either a dietary constraint (e.g., medical condition limiting food intake) or a choice? The dictionary defines fibre in food, but “inability” is not defined. It arguably means the person could not achieve that level, not merely that they chose not to. This may be interpreted restrictively.

Fourth, the physical activity factor (8)(a) requires “inability to undertake any physical activity greater than 3 METs for at least 10 consecutive years within the 30 years before the clinical onset of adenoma of the colon.” 3 METs is very low - equivalent to slow walking (around 2.5 mph). This means the person must have been so incapacitated that they could not even do slow walking. This is a very high threshold, effectively requiring significant physical disability. Most claimants with sedentary desk jobs can still walk; they would not meet “inability”. The factor is likely aimed at veterans with chronic conditions like severe arthritis or lung disease.

Fifth, the red meat factor requires an average of at least 100 grams per day for at least 5 years within 10 years. 100 grams is about a third of a steak or a small hamburger patty. Many people eat that much red meat regularly, but the key is averaging over the 5-year period. Processed meat requires 25 grams per day (one slice of ham). Both factors only apply to colon adenoma, not rectal. The low fruit/vegetable factor is an alternative: inability to consume at least 100 grams per day of any combination of fruit and veg for at least 5 years before onset. That is about one small apple or a few florets of broccoli. Again “inability” may be hard to prove.

Sixth, the factor for “having a solid organ transplant at least 5 years before the clinical onset” does not require that the transplant was related to service. So a veteran who had a kidney transplant for a non-service condition can still use this factor, provided the transplant occurred at least 5 years before the adenoma onset. That could be an easy factor to prove for transplant recipients.

Seventh, the factor for “having a ureterosigmoidostomy” is extremely rare (a surgical diversion of the ureters into the sigmoid colon, now obsolete). It only applies if the adenoma is in the affected part of the colorectum. This is a niche factor.

Eighth, the “inability to obtain appropriate clinical management” factor applies only to aggravation, not original causation. This is a gotcha for claimants whose adenoma was discovered during service but was not caused by service. They may need to show they had the adenoma before or during service, and that failure to manage it (e.g., no follow-up colonoscopy) aggravated it.

Ninth, note that the alcohol factor does not distinguish between beverage types. It uses the Australian Standard of 10 grams of alcohol. If a claimant drank only low-alcohol beer, the calculation is based on absolute alcohol. They must have consumed 250,000 grams of alcohol. That is roughly 25,000 standard drinks. The average heavy drinker consuming 6 drinks per day would take about 11.4 years to reach that. But if they only drank 2 drinks per day, it would take 34 years. Many veterans may not have reached that threshold, especially if they started drinking later in life.

Tenth, the instrument incorporates the ICD-10-AM Tenth Edition 2017. If a hospital uses a later edition, the code might differ, but the SOP relies on its own definition, not the code. The code is just for reference. However, if a death certificate lists a code under ICD-11, the SOP is silent. This could cause technical disputes.

Compliance with this SOP is relevant for two audiences: claimants seeking compensation and decision-makers assessing claims.

For a claimant, the first step is to ensure that the condition is within scope. Obtain a pathology report confirming a benign epithelial neoplasm of the colorectum, and specifically that it is not one of the exclusions (e.g., non-neoplastic polyp, familial adenomatous polyposis). If the adenoma is in the rectum, the colon-specific factors (including inactivity, red meat, processed meat, acromegaly, low fruit/veg) cannot be used. So a claimant with a rectal adenoma must rely on the non-site-specific factors: smoking, alcohol, obesity, diabetes, low fibre, transplant, ureterosigmoidostomy, or inability to manage.

Second, the claimant must identify which factors could apply and gather evidence to meet the thresholds. For smoking, obtain a life history of smoking with dates and quantities to calculate pack-years. Self-report is acceptable but must be plausible. For alcohol, document drinking patterns over decades; medical records of alcohol abuse or liver disease may help. For obesity, find medical records showing weight and height, or waist circumference measurements, for the relevant period. For diabetes, obtain medical records showing diagnosis date and evidence of duration. For fibre intake, a dietary recall or hospital dietitian notes may be needed; note that supplement fibre does not count. For red meat and processed meat, dietary histories.

For the physical inactivity factor, the claimant must show inability to perform any activity >3 METs for 10 consecutive years. This may be shown by medical disability certificates, mobility aid use, or functional assessments. For acromegaly, a diagnosis by an endocrinologist is needed. For transplant, provide transplant records. For ureterosigmoidostomy, surgical records.

Third, the claimant must show that each factor is related to relevant service. This is often the hardest part. The factor must be caused or contributed to by service. For example, smoking may be related to service if the veteran started or increased smoking due to the stresses of service. Drinking may be related if service-induced PTSD led to alcohol abuse. Obesity may be related if a service injury limits physical activity. Diabetes may be related if service caused obesity or other factors. The veteran needs to establish a nexus between the factor and service, not just the factor’s existence. Section 10(1) says: “The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.” This is a separate requirement. So even if a claimant meets the factor, they still have to show the factor itself was due to service. This is a double hurdle.

For decision-makers, the SOP is applied as follows. First, confirm the condition is colorectal adenoma per the instrument. Second, check each alleged factor. For quantitative factors, verify the calculations (pack-years, grams of alcohol, grams of meat, METs etc.). Third, ensure the timing windows are satisfied. Fourth, determine if the factor is related to service. If the claimant cannot prove the factor, the claim fails. If the factor exists and is related, the reasonable hypothesis is raised and the claim proceeds to the next stage.

Compliance for decision-makers also involves keeping the SOP updated. The instrument refers to other SOPs in section 11; decision-makers must have the current version of those SOPs.

From a broader perspective, legal advisors should keep medical experts informed of the SOP definitions. The solicitors should pre-assess the claim strength based on available evidence. Claimants should be warned about the high evidentiary burden, especially for the “inability” factors. The system imposes significant transaction costs, incentivising claimants to gather as much evidence as possible early, rather than relying on the decision-maker to seek it out. The SOP does not require the department to assist the claimant in obtaining evidence, so the burden lies squarely on the individual.