Statement of Principles concerning haemorrhoids (Reasonable Hypothesis) (No. 19 of 2026)

The central concept is the "reasonable hypothesis" standard. Under section 120A of the VEA, a claim for an injury or disease will succeed if the decision-maker is satisfied that a reasonable hypothesis exists connecting the condition with the veteran's service. This SoP provides the exclusive set of factors that can form a reasonable hypothesis for haemorrhoids; in practice, if a veteran cannot point to at least one factor in section 9, the claim will fail unless the RMA's view of the evidence is overturned or the factor is found to relate to service in some other way (though that is unlikely given the exclusive language). "Clinical onset" refers to the first appearance of symptoms or signs of haemorrhoids. "Clinical worsening" means a material increase in the severity of the condition, which may include an increase in grade, bleeding, or the need for surgical intervention, as noted in the instrument. The instrument distinguishes between factors for onset and factors for worsening, with different timeframes. For example, pregnancy within 6 weeks before onset is a factor, whereas receptive anal intercourse within 48 hours before worsening is a factor. "Relevant service" is defined in the dictionary and means operational service, peacekeeping service, hazardous service, or British nuclear test defence service under the VEA, or warlike or non-warlike service under the MRCA. The instrument applies only to these categories; peacetime service under the VEA not captured by these definitions is not covered. "Terminal event" is defined to include pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function, and is used only for death from haemorrhoids: where haemorrhoids contributed to such a terminal event, death is considered from haemorrhoids. The instrument also contains a cross-reference mechanism: if a factor in section 9 refers to an injury or disease that is itself the subject of another Statement of Principles, then that other SoP's factors are incorporated by reference as in force from time to time. This is important for factors such as spinal cord injury (which is defined in the dictionary but may also be the subject of its own SoP) or irritable bowel syndrome. The dictionary defines "fibre in food" as complex carbohydrates of plant origin that resist digestion, including cellulose and pectins. This definition matters because factor (f) and (g) require an inability to consume an average daily intake of 20 grams of fibre in food for stated periods. The instrument does not specify how to measure "inability" - it is left to medical evidence.

The direct affected class is veterans, members of Peacekeeping Forces, and members of the Forces under the VEA, plus members under the MRCA, who are claiming that haemorrhoids are related to their service. This includes former members who have already been discharged and current members who may claim during service. Their dependents are indirectly affected because if a veteran dies from haemorrhoids (or with haemorrhoids as a contributing factor), the dependent's eligibility for a widow's or widower's pension may depend on applying this SoP. The instrument also affects decision-makers within the Department of Veterans' Affairs and the Military Rehabilitation and Compensation Commission, who must apply the SoP in determining claims. Medical advisers who prepare reports for veterans will need to know the precise factors and timeframes to give useful opinions. The Repatriation Medical Authority itself is bound by its own instrument only in the sense that it has determined it, but the RMA may later revoke or amend it. The Veterans' Review Board and the Administrative Appeals Tribunal will also be required to apply the SoP on review. Legal practitioners representing veterans need to understand the factors and the interplay with other SoPs, particularly where a veteran has multiple conditions. The instrument also potentially affects the medical profession in that the definition of haemorrhoids excludes anorectal varices, which may lead to diagnostic disputes. The broader taxpayer is affected because if more claims succeed under these factors, the compensation liability of the Commonwealth increases. Conversely, if the factors are more restrictive than the previous 2017 SoP, fewer claims may succeed, reducing cost. The instrument does not have a direct impact on private enterprise or competition. However, the compliance burden on veterans is significant: they must produce evidence of a factor within specific time windows, often requiring contemporaneous medical records. For example, straining at stool due to constipation or diarrhoea within 2 weeks before clinical onset requires proof of that specific short window. Veterans without detailed medical records from their service period may struggle. The instrument also may affect veterans who had haemorrhoids before service and then aggravated: the worsening factors apply only if the original condition existed before or during service but did not arise out of service. This creates a two-step inquiry.

The instrument imposes a duty on the RMA to determine a SoP under subsection 196B(2) of the VEA, which it has done here. The RMA's duty is to base its determination on sound medical-scientific evidence. The instrument itself does not create duties on veterans; rather, it creates a right: if a veteran can establish at least one factor in section 9 that is related to their relevant service, then a reasonable hypothesis is raised and the claim must succeed unless the decision-maker can disprove the hypothesis beyond reasonable doubt (under the operational service standard) or on the balance of probabilities (for other service). In practice, the SoP functions as a gatekeeper. The right of the veteran is to have their claim assessed in accordance with the SoP. If a veteran cannot meet any factor, the claim will be rejected. The instrument also gives the veteran the right to rely on the cross-reference mechanism: if a factor refers to another injury or disease, the corresponding SoP for that condition applies. This prevents the veteran from having to separately establish the same factor under a different analysis. However, that right is contingent on the other SoP being in force from time to time. The decision-maker has a duty to apply the SoP correctly, including the definitions and timeframes. The decision-maker must also apply section 10(1): each factor must be related to the relevant service rendered. That is a separate inquiry: even if a factor exists, the decision-maker must ask whether the factor itself is service-related. For example, if a veteran has irritable bowel syndrome, that condition must itself be related to service (or be covered by its own SoP). The instrument does not give the decision-maker discretion to accept factors outside section 9 as raising a reasonable hypothesis; the factors are exhaustive. The only exception might be if the RMA's view of the medical-scientific evidence is challenged, but that is not something the decision-maker can do at the claim level. The dictionary definition of "anticoagulants" includes heparin, warfarin, dicumarol, dabigatran, apixaban, and rivaroxaban. This is an exhaustive list, not illustrative. A veteran taking a different anticoagulant not listed would not satisfy factor (k) unless the drug falls within the general definition (agents that suppress, delay or attenuate blood coagulation). Similarly, "antiplatelet agents" is defined to include aspirin, clopidogrel, dipyridamole, monoclonal antibodies and peptides. The inclusion of "monoclonal antibodies" is broad and may capture newer drugs. The duty on the veteran is to provide evidence of the intake within 30 days before hemorrhoidal bleeding.

This instrument does not itself impose penalties for non-compliance. It is a legislative rule that sets criteria for entitlement to benefits. Enforcement of the criteria is built into the claims process. If a decision-maker incorrectly applies the SoP, the veteran can seek review by the Veterans' Review Board (under Part XI of the VEA) and then appeal to the Administrative Appeals Tribunal and ultimately the Federal Court. There is no penalty on the decision-maker for error other than the possibility of an adverse costs order on review or judicial review proceedings. The instrument does not create any criminal offences. However, there are potential consequences for a veteran who makes a false or misleading statement in support of a claim under the VEA or MRCA. Those consequences are found in the Criminal Code and the social security fraud provisions (though veterans' law has its own provisions under s 202 of the VEA for false statements). A veteran who knowingly fabricates evidence of, say, chewing khat at least weekly for 3 months before onset to meet factor (e) could face prosecution. The instrument itself does not reference penalties, but the broader legal framework does. From a compliance burden perspective, the instrument's design imposes costs on veterans to gather evidence. For example, factor (j) requires "receptive anal intercourse within the 48 hours before clinical worsening." This is a very short window and may be difficult to prove without credible contemporaneous evidence. The practical enforcement relies on the veteran's honesty and the decision-maker's ability to assess credibility. The instrument also does not specify how to quantify "inability to consume an average daily intake of 20 grams of fibre" - is that a medical determination of a dietary restriction, or a practical inability? The note to factor (l) says "inability to obtain appropriate clinical management for haemorrhoids before clinical worsening." This factor could be broad, but it requires that the inability be related to service. If a veteran served in a remote location without access to surgical management, that could be argued. But the decision-maker must be satisfied that appropriate clinical management was not obtainable due to service circumstances, not merely because the veteran chose not to seek treatment. The risk of over-claiming on this factor is high. The instrument's enforcement is essentially self-policing through medical evidence, but administrative review may overturn decisions that are not soundly based.

The primary interaction is with the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. Specifically, section 120A of the VEA requires that a claim for an injury or disease must be determined in accordance with any relevant Statement of Principles determined under subsection 196B(2). This SoP is such a Statement. Section 338 of the MRCA similarly requires the application of SoPs. The instrument repeals the previous 2017 SoP, so any claim not finally determined before 23 March 2026 must be decided under this instrument. The instrument also interacts with other SoPs. Under section 11, if a factor in section 9 refers to an injury or disease in respect of which another SoP has been determined, then the factors in that other SoP apply. This means that for a factor such as "having a spinal cord injury" (factor (c)), the decision-maker must look to the SoP for spinal cord injury (if one exists) to determine whether that condition itself raises a reasonable hypothesis with service. If the veteran has a spinal cord injury acquired on service, then factor (c) is satisfied via that SoP. If the spinal cord injury is not service-related, factor (c) cannot be used because section 10 requires the factor to be related to the service. So the interaction is two-layered: the factor must exist, and the factor must be service-related, which is often determined through its own SoP. The instrument also defines "haemorrhoids" by reference to ICD-10-AM code K64, O22.4 or O87.2, but only for noting the code; the meaning is the instrument's own definition. This avoids the code driving the legal definition. The dictionary defines "relevant service" cross-referencing the VEA and MRCA categories. This means the instrument does not apply to claims under the Safety, Rehabilitation and Compensation Act 1988 (for civilian Commonwealth employees) or under state workers' compensation schemes. The instrument's factors also interact with medical causation principles in tort law, but that is not directly relevant. The instrument does not interact with state laws on health practitioners or medical records. However, the definition of "fibre in food" uses medical/ nutritional terminology; if a dispute arises, expert evidence may be needed. The instrument does not limit or expand any other legal rights; it is a specific administrative tool. There is no mention of privacy laws, but medical records used to prove factors must comply with the Privacy Act. The instrument's cross-reference mechanism also means that subsequent amendments to other SoPs are incorporated automatically, which could change the criteria for a claim mid-stream if the RMA updates the referenced SoP. This is a potential source of uncertainty for veterans.

This instrument is a replacement for the Statement of Principles concerning haemorrhoids (Reasonable Hypothesis) (No. 3 of 2017) (F2017L00004). The 2017 SoP is repealed by section 4 of the current instrument. The new instrument was made on 20 February 2026 and commences on 23 March 2026. The instrument does not provide a summary of changes from the previous version; a practitioner would need to compare the two instruments. However, the RMA typically updates SoPs when new medical evidence emerges or when the ICD coding changes. The 2017 SoP has been in force for approximately nine years. The new instrument includes factors not present in the 2017 version? Without the 2017 text, we cannot comment on specific differences, but the structure of section 9 (13 factors) may differ. The instrument adds a new factor (l) "inability to obtain appropriate clinical management for haemorrhoids before clinical worsening" and factor (j) "receptive anal intercourse within the 48 hours before clinical worsening" which may be new. The definition of haemorrhoids now explicitly excludes anorectal varices, which may have been included in the old definition? Not known. The instrument also updates the dictionary definitions; for example, "anticoagulants" now includes dabigatran, apixaban, and rivaroxaban (newer direct oral anticoagulants). The 2017 SoP may not have listed these. The repeal is automatic and the new instrument applies to claims to which section 120A VEA or section 338 MRCA applies. There is no transitional savings clause; the instrument says "This instrument applies to a claim to which section 120A of the VEA or section 338 of the MRCA applies." This suggests that any claim made after commencement, or any claim that has not been finally determined before commencement, will be decided under the new instrument. This could create hardship for veterans who had assembled evidence under the old factors and now must meet different criteria. The RMA does not provide a transitional period. The instrument is a legislative instrument and is subject to disallowance by Parliament under the Legislation Act 2003, though that is unlikely. Future amendment history will be recorded on the Federal Register of Legislation.

The instrument is brand new (commencement 23 March 2026) and has no litigation history. No court or tribunal has yet interpreted its provisions. However, previous Statements of Principles concerning haemorrhoids have been the subject of administrative review. The now-repealed 2017 SoP and earlier versions may have been tested in the Veterans' Review Board and the Administrative Appeals Tribunal. For example, the meaning of "clinical onset" and "clinical worsening" often generates disputes. The definition of "haemorrhoids" excluding anorectal varices could lead to litigation if a veteran's condition is diagnosed as anorectal varices or if a medical opinion conflates the two. The factor "inability to obtain appropriate clinical management" is likely to be litigated because it is subjective and requires proof that appropriate management was not available. The term "appropriate clinical management" is not defined; it invites argument about what is appropriate in the circumstances of service. The factor "straining at stool due to constipation or diarrhoea, within the 2 weeks before clinical onset" may be litigated over the causal specificity: is the straining itself the factor, or does it require that the constipation or diarrhoea be due to service? The instrument's note says "clinical worsening of haemorrhoids may include an increase in the grade of the haemorrhoids, bleeding and/or the need for surgical intervention" - this may be used by decision-makers to narrow what constitutes worsening. The Veterans' Review Board and AAT have previously considered similar language in other SoPs. The new factor (j) regarding receptive anal intercourse within 48 hours before clinical worsening may raise issues of evidence and privacy; it is a very specific time window and may be difficult to prove. The Administrative Appeals Tribunal may have to consider the weight of self-reporting versus medical records. There is no case law on this specific factor yet. The instrument may also be challenged by way of judicial review if the RMA is alleged to have acted beyond power or if the factors are not based on sound medical-scientific evidence. Given the low likelihood of such a challenge succeeding, but it remains possible. Any litigation will likely focus on the proper construction of the factors and definitions, not on the validity of the instrument itself.

Several traps await the unwary. First, the definition of haemorrhoids excludes anorectal varices. A veteran diagnosed with "anorectal varices" does not have haemorrhoids for the purposes of this SoP, even if the clinical presentation is similar. This may lead to a claim being rejected despite significant symptoms. Second, the time windows are critical. For onset, pregnancy must be within 6 weeks before onset; for worsening, receptive anal intercourse within 48 hours before worsening; for bleeding from anticoagulants, within 30 days before the bleeding. Missing a deadline by even a day can break the causal link. Third, the fibre factor requires "inability to consume an average daily intake of 20 grams of fibre in food." This is not simply a low-fibre diet; it must be an inability due to service circumstances (e.g., service in a war zone where fresh produce is unavailable). A veteran who chose to eat poorly will not satisfy this factor. The requirement is for at least 3 months before onset or 4 weeks before worsening. Fourth, factor (l) "inability to obtain appropriate clinical management for haemorrhoids before clinical worsening" may seem like a catch-all but requires that the inability be service-related and that clinical worsening occurs because of that inability. If a veteran could have sought treatment after service but did not, this factor will not apply. Fifth, the cross-reference mechanism in section 11 means that if a factor refers to another injury or disease, you must also satisfy that other SoP. For example, irritable bowel syndrome as a factor requires that the IBS itself be related to service per its own SoP. Sixth, the instrument only applies to "relevant service" defined in the dictionary: operational, peacekeeping, hazardous, British nuclear test, warlike, non-warlike. A veteran who served only peacetime garrison service is not covered, even if they have a strong case. Seventh, the note to factor (d) about pelvic space occupying lesions includes tumours outside the pelvis if they impinge on rectal veins. This is broad, but the lesion must be "of sufficient size" - an opinion likely requiring radiological evidence. Eighth, the "clinical worsening" factors at subsections 10(2) apply only where haemorrhoids existed before or during service but did not arise out of service. This means if the original haemorrhoids arose out of service, the worsening factors are unnecessary; the whole condition is service-related. If they arose pre-service and were aggravated, the worsening factors apply. Ninth, the definition of "terminal event" is exhaustive; if a veteran dies from a cause not listed (e.g., sepsis from haemorrhoids), it may not be considered death from haemorrhoids unless sepsis can be linked to one of the listed events. Tenth, the instrument does not define "symptomatic enlargement" - this could lead to disputes over what counts as symptom.

For a veteran seeking to rely on this SoP, compliance means first ensuring the claim is for haemorrhoids as defined (including symptoms like bleeding, thrombosis, prolapse) and not anorectal varices. They must then gather evidence to establish at least one factor from section 9, and that the factor is related to their relevant service. Practical steps: obtain contemporaneous medical records from the period around clinical onset or worsening. For straining due to constipation or diarrhoea, keep a diary or have medical notes documenting the timing. For the fibre factor, obtain evidence that dietary fibre intake was below 20g average daily due to service constraints. For spinal cord injury, obtain the diagnosis and link to service. For khat chewing, gather statements from witnesses or unit records showing regular use. For anticoagulant/antiplatelet/NSAID use, obtain pharmacy records or prescription records showing intake within 30 days of hemorrhoidal bleeding. For receptive anal intercourse, this may be difficult to document; but if it is relevant, a statement and medical evidence of the aggravation within 48 hours is necessary. For inability to obtain clinical management, show that the veteran was unable to access treatment due to service location or other service-related barriers. The veteran should also consider whether the factor itself refers to another condition (e.g., irritable bowel syndrome) and ensure that condition meets its own SoP. The decision-maker must comply by applying the factors strictly. They should first determine the date of clinical onset or clinical worsening, then check each factor against the evidence, ensuring the time windows are met. They must also apply section 10: each factor must be related to relevant service. For factors that are themselves conditions, the decision-maker must apply the cross-reference mechanism in section 11, applying the relevant SoP for that condition as in force from time to time. If the factor is satisfied but the underlying condition is not service-related, the claim fails. The decision-maker should also note that the instrument is exhaustive: no other hypothesis is permissible unless the RMA's own view is challenged. The decision-maker must also apply the appropriate standard of proof (reasonable hypothesis for operational service; reasonable satisfaction for other service). The dictionary definitions must be used, not ordinary meanings. For example, "fibre in food" is defined; common foods may not meet the definition if they are processed. The decision-maker should seek expert medical evidence where necessary, particularly on the existence of "pelvic space occupying lesion of sufficient size" or on the clinical onset/worsening timeline. Finally, any decision should record which factor is found to exist and why it relates to service, to ensure transparency and facilitate review.