Statement of Principles concerning familial adenomatous polyposis (Reasonable Hypothesis) (No. 77 of 2021)

This instrument is a Statement of Principles concerning familial adenomatous polyposis (Reasonable Hypothesis) (No. 77 of 2021), made by the Repatriation Medical Authority (RMA) under subsection 196B(2) of the Veterans' Entitlements Act 1986 (the VEA) (s 1, s 3). It takes effect on 26 July 2021 (s 2) and expressly repeals a previous RMA Statement of Principles on the same condition, Familial Adenomatous Polyposis No. 39 of 2013 (s 4).

Mechanically, the instrument does four things. First, it defines the medical entity to which the Statement applies: familial adenomatous polyposis (FAP), described as an inherited autosomal dominant syndrome caused by germ-line mutation of the adenomatous polyposis coli (APC) gene and characterised by formation of more than 100 colorectal adenomas (s 7(2)). Second, it treats death from FAP as including death from a terminal event or condition that was contributed to by the person’s FAP, with “terminal event” exemplified in the Schedule (s 7(3), Schedule). Third, it states the RMA’s view that there is sound medical‑scientific evidence indicating FAP and death from FAP can be related to relevant service (s 8). Fourth, and most operationally important for claims, it prescribes the single factor that must, as a minimum, exist before it can be said that a “reasonable hypothesis” has been raised connecting FAP or death from FAP with the circumstances of a person’s relevant service: inability to obtain appropriate clinical management for FAP (s 9). The instrument also limits the circumstances in which that factor can establish material contribution or aggravation: it applies only where the person’s FAP was suffered or contracted before or during, but did not arise out of, the person’s relevant service (s 10).

Procedurally, the instrument applies to claims to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 (MRCA) applies (s 5). The Schedule supplies short definitions used in the instrument, including the definition of relevant service (which lists operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike and non‑warlike service under the MRCA) and examples of terminal events (Schedule). The instrument contains no express penalties or enforcement regime; it is a determinative administrative instrument intended to be applied in the decision‑making process for veterans’ claims (s 3, s 5).

This Statement therefore replaces the earlier SOP, supplies a medical definition of FAP and death from FAP, establishes the evidential threshold factor (inability to obtain appropriate clinical management) needed to raise a reasonable hypothesis linking FAP to relevant service, and confines its application to conditions suffered or contracted before or during,but not as a result of,service (s 4, s 7(2)-(3), s 8-10, Schedule).

The instrument deploys a small number of tightly specified concepts as the basis for administrative decision making. Those concepts are defined in the body of the instrument or in the Schedule and are the anchors for claims assessment.

Familial adenomatous polyposis (FAP)

• Defined as an inherited autosomal dominant syndrome caused by germ‑line mutation of the APC gene, characterised by the formation of more than 100 colorectal adenomas (s 7(2)). The instrument treats this definition as the operative medical description for claims under the Statement.

Death from familial adenomatous polyposis

• Includes death from a terminal event or condition that the person’s FAP contributed to (s 7(3)). The Schedule supplies examples of terminal events: pneumonia, respiratory failure, cardiac arrest, circulatory failure, and cessation of brain function (Schedule, terminal event).

Relevant service

• The instrument is expressly limited to claims that arise within the statutory frameworks of the VEA and MRCA and then only to “relevant service”, which the Schedule defines by a list: operational service, peacekeeping service, hazardous service and British nuclear test defence service under the VEA; and warlike or non‑warlike service under the MRCA (Schedule, relevant service). The instrument therefore ties its applicability to categories of service already recognised in veterans’ law.

Reasonable hypothesis and the minimum factor

• The RMA records that it is of the view there is sound medical‑scientific evidence that FAP and death from FAP can be related to relevant service (s 8). Despite that view, the instrument stipulates that before a “reasonable hypothesis” is raised connecting FAP or death from FAP with the circumstances of relevant service, one factor must exist at minimum: inability to obtain appropriate clinical management for FAP (s 9). The instrument does not further define “inability to obtain appropriate clinical management” or “appropriate clinical management” within the text or Schedule.

Temporal relationship and causation caveat

• The relationship provision in s 10 restricts the application of the factor to material contribution to or aggravation of FAP only where the person’s FAP was suffered or contracted before or during, but did not arise out of, the person’s relevant service (s 10). In other words, the instrument is directed at cases where service may have affected the course or management of pre‑existing or pre‑service/within‑service conditions but is not expressed to cover conditions that arose out of the service itself.

Primary categories of persons and decision points are specified by the instrument; the chain of affected parties extends from individual claimants to the administrative decision‑makers who apply the Statement.

Claimants (veterans, members of the Forces and families)

• The instrument applies to “a claim to which section 120A of the VEA or section 338 of the MRCA applies” (s 5). That means the Statement is relevant to veterans, members of Peacekeeping Forces, or members of the Forces who lodge claims under those statutory provisions, and by extension to dependants or estates making death claims where death is alleged to be from or contributed to by FAP (s 5, s 7(3)). The Schedule’s definition of “relevant service” makes clear that claimants who rendered operational, peacekeeping, hazardous, British nuclear test defence service (VEA categories), or warlike or non‑warlike service (MRCA categories) fall within the class to which the instrument can apply (Schedule).

Persons with the defined medical condition

• The instrument narrowly defines the medical entity as germ‑line APC mutation with more than 100 colorectal adenomas (s 7(2)). Individuals whose clinical picture does not meet that definition , for example, those without a demonstrated APC germ‑line mutation or without the >100 adenomas threshold , lie outside the definition that the RMA uses here. Death claims are included where a terminal event was contributed to by FAP (s 7(3), Schedule).

Decision‑makers and adjudicators

• The RMA itself made the Statement under the VEA power (s 3). The instrument is intended to be applied in the administrative decision‑making processes governed by the VEA and MRCA (s 5). Although the instrument does not set out the precise obligations of decision‑makers, it supplies the medical view and the minimum factor (inability to obtain appropriate clinical management) that must exist before a reasonable hypothesis linking FAP to service may be considered (s 8-9). As an RMA Statement of Principles, it is the medical evidence base that adjudicators and internal decision‑makers will use when conducting the statutory reasonable hypothesis assessment in relevant claims.

Health service providers and clinical management system

• The central factor required by the instrument is inability to obtain appropriate clinical management (s 9). That places health service availability, referral pathways, and access to specialist care into the causal chain for claims. Although the instrument does not regulate providers, it makes access to clinical management an evidentiary hinge; therefore public or private providers and system capacity may be implicated for claimants seeking to establish the necessary factor.

The instrument itself is not a statute that imposes criminal sanctions; rather, it establishes an RMA medical position and prescribes the minimum evidential factor required to raise a “reasonable hypothesis” linking familial adenomatous polyposis (FAP) or death from FAP with relevant service. Its operative legal effects for rights and duties derive from that role in the claims process.

Rights

• Right to have a claim assessed under this Statement: where a person lodges a claim covered by section 120A of the VEA or section 338 of the MRCA, the Statement is applicable for determining whether a reasonable hypothesis exists with respect to FAP or death from FAP (s 5). The Statement defines the medical condition (s 7(2)) and the scope of death claims (s 7(3)), thereby clarifying the class of conditions and deaths that the RMA regards as potentially related to relevant service (s 8).

• Right to rely on the RMA’s asserted “sound medical‑scientific evidence”: the RMA records it has reached the view that sound evidence indicates FAP and death from FAP can be related to relevant service (s 8). That statement functions for claim processes as the RMA’s medical position, which decision‑makers apply in the statutory reasonable hypothesis assessment under the VEA/MRCA framework (s 3, s 5).

Duties and operational constraints on claimants and decision‑makers

• Minimum factor duty: The Statement prescribes a single minimum factor that must exist before a reasonable hypothesis can be raised: inability to obtain appropriate clinical management for FAP (s 9). While the instrument does not state procedural duties for claimants, the practical effect is that claimants bear an evidentiary task to establish that the prescribed factor exists, because the factor is necessary to raise the reasonable hypothesis in their favour.

• Temporal limitation on application: Section 10 limits the Statement’s application to material contribution to or aggravation of FAP where the person’s FAP was suffered or contracted before or during, but did not arise out of, the person’s relevant service (s 10). Decision‑makers must therefore assess the timing of the condition relative to service and whether the FAP “arose out of” service; only those with FAP suffered or contracted before or during service fall within the scope for material contribution/aggravation under this Statement.

• Administrative duty to apply the Statement: The instrument is made under the RMA’s statutory power (s 3) and applies to claims under the specified statutory provisions (s 5). That structure creates an administrative obligation for adjudicators to consider the RMA’s Statement when applying the reasonable hypothesis standard in relevant claims, although the instrument does not reproduce the broader statutory decision‑making provisions of the VEA/MRCA.

The Statement of Principles instrument contains no penal provisions and does not itself create criminal or civil penalties. It is an administrative determination made under subsection 196B(2) of the VEA (s 3) intended to inform the operation of claims under the VEA and MRCA (s 5). The instrument’s text contains no enforcement mechanisms, fines, or sanctions directed at claimants, health practitioners or other private parties.

Operational enforcement and administrative effect

• The instrument’s enforcement mechanism is practical and procedural: it supplies the RMA’s medical view and specifies the minimum factor necessary to raise a reasonable hypothesis connecting FAP or death from FAP to relevant service (s 8-9). The procedural consequence is that decision‑makers applying the VEA and MRCA provisions will accept the RMA’s Statement as the medical basis for assessing reasonable hypothesis, and will require the existence of the factor set out in s 9 before treating a claim as meeting the reasonable hypothesis threshold. Any administrative adverse decision or acceptance flows from the statutory decision‑making processes under the VEA/MRCA, not from the Statement itself (s 5).

No direct compulsion on health systems

• Although the Statement centrally concerns “inability to obtain appropriate clinical management” (s 9), it does not itself require public or private health providers to deliver care, nor does it impose obligations on health services. It is not an instrument that mandates service provision or directs budgets. Consequently, the “enforcement” to which the Statement can give rise is administrative (i.e. whether a claim is accepted) rather than regulatory enforcement against hospitals or practitioners.

Relevance to appeals and review

• Because the Statement is an RMA determination under the VEA, the usual statutory review and appeal channels that apply to decisions under the VEA and MRCA will be the paths for contesting how this Statement has been applied. The Statement itself does not set out those review mechanisms; it should be read as supplying medical criteria that decision‑makers must apply within the VEA/MRCA procedural framework (s 3, s 5).

Absence of statutory definitions for the central factor

• The key operational hinge for acceptance of claims is the existence of inability to obtain appropriate clinical management (s 9). The Statement does not define that phrase, nor prescribe what evidence or standard of proof must be met to demonstrate inability to obtain clinical management. That absence is a procedural gap that will translate into administrative discretion in decision‑making, but the Statement contains no enforcement or oversight mechanisms to constrain how that discretion is exercised.

This Statement of Principles is an RMA instrument made under a specific provision of the VEA and is designed to integrate into the existing statutory decision frameworks for veterans’ entitlements and military compensation. The instrument therefore interacts with other laws principally by supplying the medical and evidentiary criteria used within statutory assessment processes.

Statutory provenance and application

• The instrument is made under subsection 196B(2) of the VEA (s 3). It explicitly applies to claims “to which section 120A of the VEA or section 338 of the MRCA applies” (s 5). Those cross‑references mean the Statement is an input into the VEA and MRCA claim assessment processes. The VEA and MRCA contain the statutory mechanisms for raising and applying the “reasonable hypothesis” test; the RMA’s Statement provides the medical/scientific basis and the minimum factor the decision‑maker must consider in applying that test for FAP and death from FAP (s 3, s 5, s 8-9).

Replacement of prior RMA material

• The instrument expressly repeals the prior Statement of Principles concerning familial adenomatous polyposis No. 39 of 2013 (s 4). For administrative purposes, the 2021 Statement supersedes the 2013 Statement and becomes the operative RMA position to be applied in VEA/MRCA claims from its commencement date (s 2-4). Any decisions or assessments made after commencement should rely on the 2021 Statement as the authoritative RMA medical view.

Definitions cross‑referencing VEA and MRCA categories

• The Schedule defines “relevant service” by reference to categories under both the VEA and the MRCA, including operational, peacekeeping, hazardous, British nuclear test defence service (VEA), and warlike and non‑warlike service (MRCA) (Schedule). The Statement therefore works in tandem with the VEA and MRCA definitions of service type and their associated entitlements and procedural rules.

No modification of VEA/MRCA statutory rights or obligations

• The instrument does not itself amend the VEA or MRCA. It does not create or remove statutory entitlements; instead, it provides the RMA’s medical finding and sets the evidentiary threshold for reasonable hypothesis in the context of those Acts. The VEA/MRCA decision‑making and review processes remain the legal mechanisms that determine entitlements and remedies.

Evidentiary and interpretive interactions

This instrument records one express amendment event: it repeals the prior Statement of Principles concerning familial adenomatous polyposis No. 39 of 2013 (Federal Register of Legislation No. F2013L01126). That repeal is set out in section 4 (s 4). The instrument itself is identified as No. 77 of 2021 in its title and the prefatory matter (instrument name at s 1 and heading information). It is dated 25 June 2021 and commences on 26 July 2021 (s 1-2; prefatory material). The instrument was sealed by the Chairperson of the RMA, whose name appears on the instrument as the official attestation.

No other amendments or modifications to the Statement are recorded within the instrument. There are no transitional provisions or savings clauses included in the text that would indicate how claims assessed under the prior 2013 Statement are to be treated post‑repeal. The absence of transitional directions means that, from its commencement date, the 2021 Statement operates in place of the 2013 Statement for claims “to which section 120A of the VEA or section 338 of the MRCA applies” (s 2-5). Practitioners should therefore assume that assessments performed after 26 July 2021 will be conducted against the 2021 Statement unless other administrative guidance or legislative amendment outside this instrument provides transitional detail.

The instrument’s Schedule contains definitions that are part of the Statement and should be read as integral to it. There are no footnotes or explanatory amendments embedded in the body to signal later adjustments. The instrument’s repeal of the 2013 Statement is categorical; the text does not preserve any discrete elements of the earlier Statement or indicate staged change.

If future RMA Statements or legislative amendments alter the definitions, the minimum factor, or the applicability of the Statement to different categories of service, those will be recorded as subsequent instruments or legislative changes. As of the date of the instrument itself, the amendment history is limited to the repeal of the 2013 Statement, replacement by this 2021 Statement, and the specified commencement date (s 2-4).

The instrument does not include or record any litigation history. It is a Statement of Principles made by the Repatriation Medical Authority under the VEA (s 3), and its text contains no references to judicial determinations, appeals, or prior litigation concerning this instrument or the replaced 2013 Statement.

Because the document supplied is the instrument itself and not a court digest or administrative decision record, there are no case citations, appeal outcomes, or judicial interpretations set out in its text. The Statement therefore contains no litigation history within its contents.

For practitioners seeking to understand how this Statement has been applied in practice or reviewed by courts or tribunals, the absence of litigation references in the instrument means one must search administrative decision records, tribunal determinations and court judgments external to the instrument to locate any applications, appeals or judicial commentary that refer to or engage with this specific RMA Statement. The instrument itself provides the RMA’s medical position and the operative definitions and factor but not any subsequent case law construing or applying it.

In short, the instrument carries no internal litigation history; any such history must be sourced from external judicial or tribunal records, which are not included in the instrument text.

This Statement contains several tightly framed provisions and several notable absences that materially affect how it will operate in practice. Those points are potential pitfalls for claimants, decision‑makers and advisers.

1. Key factor is singular and undefined

• The instrument makes “inability to obtain appropriate clinical management for familial adenomatous polyposis” the single minimum factor that must exist before a reasonable hypothesis can be raised (s 9). The term “inability to obtain appropriate clinical management” and the phrase “appropriate clinical management” are not defined in the Statement or the Schedule. That omission leaves a major evidentiary and interpretive gap. Decision‑makers will need to exercise judgment about what constitutes “inability” and what level or kind of clinical management is “appropriate”. The lack of definition creates scope for administrative discretion and potential inconsistency between decisions.

2. The Statement is confined to conditions not arising out of service

• Section 10 restricts the Statement’s application to cases where the person’s FAP “was suffered or contracted before or during (but did not arise out of) the person’s relevant service” (s 10). If a person’s FAP arose out of service, the specific material contribution/aggravation pathway under this Statement does not apply. That caveat can be counterintuitive: the Statement does not provide for situations where service is alleged to be the primary cause of FAP, but instead addresses situations where service may have materially contributed to or aggravated a pre‑existing or pre‑service/within‑service condition.

3. Narrow clinical definition of FAP

• The medical definition requires an APC germ‑line mutation and formation of more than 100 colorectal adenomas (s 7(2)). Individuals with attenuated forms of polyposis, fewer adenomas, or lacking a demonstrated germ‑line APC mutation may fall outside the Statement’s definition. Practitioners should not assume that less typical phenotypes of colorectal polyposis or non‑APC genetic causes are covered by this Statement.

4. Death provision requires contribution to a terminal event

• Death from FAP is defined to include deaths from a terminal event or condition that the FAP contributed to (s 7(3)). The Schedule lists examples of terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function), but the operative issue is contribution by FAP to the terminal event. Establishing contribution will require medico‑legal linkage, and the Statement does not set out evidentiary standards for proving contribution.

This section sets out practical, source‑grounded steps that claimants, advisers and decision‑makers should follow to align with the requirements of the Statement. Each step is rooted in the instrument’s operative provisions.

1. Confirm the claim is within the Statement’s statutory scope

• Verify that the claim is a claim “to which section 120A of the VEA or section 338 of the MRCA applies” (s 5). If the claim lies outside those statutory routes, the Statement will not be the operative RMA instrument for the reasonable hypothesis assessment.

2. Establish the medical diagnosis per the Statement’s definition

• Obtain objective medical evidence demonstrating the condition meets the Statement’s definition: an inherited autosomal dominant syndrome caused by germ‑line APC mutation with formation of more than 100 colorectal adenomas (s 7(2)). Practical evidence includes genetic testing records confirming APC germ‑line mutation, colonoscopy and histopathology reports documenting adenoma counts and characteristics, and specialist clinical letters diagnosing FAP.

3. For death claims, obtain cause of death and contribution evidence

• Where death is claimed to be “from familial adenomatous polyposis”, procure death certification and medical records that document the terminal event and any medical opinions that link the terminal event to FAP (s 7(3), Schedule). The Schedule lists examples of terminal events; clinical records demonstrating that FAP contributed to such an event will be central.

4. Demonstrate timing required by section 10

• The Statement applies to material contribution to or aggravation of FAP only where the FAP “was suffered or contracted before or during (but did not arise out of) the person’s relevant service” (s 10). Compile service medical records, pre‑service medical evidence, and contemporaneous clinical notes to establish when the FAP was suffered or contracted relative to service. If evidence shows the condition arose out of service, this particular Statement’s material contribution/aggravation pathway does not apply.

5. Assemble evidence to show inability to obtain appropriate clinical management

• Because s 9 makes inability to obtain appropriate clinical management the necessary minimum factor, collect documentary proof demonstrating inability or barriers to obtaining appropriate care. Relevant materials might include: