Statement of Principles concerning hookworm infection (Reasonable Hypothesis) (No. 67 of 2025)

The instrument's central legal and medical concepts are specified and defined in the body and Schedule 1. "Hookworm infection" is defined as infection by certain named parasitic species: Necator americanus, Ancylostoma duodenale, Ancylostoma ceylanicum, Ancylostoma caninum, Ancylostoma braziliense, Ancylostoma tubaeforme, Uncinaria stenocephela, and Bunostomum phlebotomum (section 7(2)(a)). It expressly includes both intestinal hookworm infection and extraintestinal hookworm infection (cutaneous larva migrans) (section 7(2)(b)). The instrument notes that hookworm infection attracts ICD‑10‑AM code B76 but specifies that the statutory meaning for this Statement is that given in subsection 7(2) (section 7(3) and note).

Death from hookworm infection is incorporated by reference to terminal events. The Statement provides that hookworm infection, in relation to a person, includes death from a terminal event or condition that was contributed to by the person’s hookworm infection (section 7(4)). The Schedule defines "terminal event" as the proximate or ultimate cause of death and gives a non‑exclusive list: pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function (Schedule 1).

The legal threshold used is the "reasonable hypothesis" standard. Section 9 sets out the factors that "must as a minimum exist" before it can be said that a reasonable hypothesis has been raised connecting hookworm infection or death from hookworm infection with relevant service. The required minimum is that at least one of the enumerated exposure or management factors applies, and that the factor is related to the person’s relevant service (sections 9 and 10(1)). The exposure factors are time‑limited: exposure described in section 9(1) must have been within the six years before clinical onset (section 9(1) introduction). The factors include specified routes of exposure (contact with contaminated soil or sand; contact with contaminated human or animal faeces; ingestion of contaminated food, drink or dust; being in tropical or subtropical regions with poor sanitation; or being in warm and damp conditions with poor sanitation) (section 9(1)(a)-(e)), and an additional factor covers inability to obtain appropriate clinical management for hookworm infection before clinical worsening (section 9(2)).

"Relevant service" is defined in the Schedule and includes operational, peacekeeping and hazardous service under the VEA, British nuclear test defence service under the VEA, and warlike and non‑warlike service under the MRCA (Schedule 1). Section 11 provides that if a factor in section 9 refers to an injury or disease already covered by a different Statement of Principles, then the factors in that other Statement apply in accordance with its terms as in force.

The Authority's statutory source for the instrument is subsection 196B(2) of the VEA (section 3), which empowers it to determine Statements of Principles. The instrument repeals the prior Statement for hookworm (No. 7 of 2017) (section 4). The mechanics therefore combine a list of medically‑relevant species, exposure paths and time limits, and a linkage rule tying those factors to relevant service for claims assessment under the VEA and MRCA frameworks.

The instrument directly affects persons making claims under the VEA or MRCA provisions referenced in section 5: claims to which section 120A of the VEA or section 338 of the MRCA applies. Those provisions are the statutory gateways for entitlement and compensation claims where a condition is alleged to be connected to service. The Schedule defines "relevant service" and so delineates the categories of covered service: operational service, peacekeeping service, hazardous service, British nuclear test defence service under the VEA, and warlike and non‑warlike service under the MRCA (Schedule 1). Consequently, the primary population affected is veterans and members of the Forces whose service falls within those categories and who claim hookworm infection or death from hookworm infection as related to that service.

The instrument affects medical evidence and claims preparation. Because it sets the minimum factors that must exist to raise a reasonable hypothesis, claimants, their medical advisers and legal or advocacy representatives will need to present medical and service history evidence that maps to the listed exposure pathways or to the inability to obtain appropriate clinical management. The six‑year exposure window before clinical onset (section 9) will be a consequential evidential constraint: it limits the temporal range in which exposure histories can establish the required hypothesis, except insofar as other Statements of Principles cover related conditions (section 11).

Decision‑makers in the claims process will also be affected, in that they must apply this Statement when assessing whether a reasonable hypothesis exists. The instrument does not itself name the decision‑maker who applies the Statement, but by its application clause it is tied to the statutory claims processes under the VEA and MRCA. The Repatriation Medical Authority is the body that determines the Statement (section 3), and the Statement expresses the Authority’s view of relevant medical‑scientific evidence (section 8). The instrument therefore shapes evidentiary thresholds for adjudicators, clinicians preparing opinions, and case managers.

Families and estates of deceased persons who claim death was contributed to by hookworm infection are affected through the inclusion of death from hookworm infection in the Statement (section 7(4) and Schedule 1 definition of terminal event). Where death is alleged, the terminal event list in the Schedule may guide causal analysis for claimants and decision‑makers.

The instrument does not specify entitlements, compensation amounts, or procedural timelines, and it does not create new criminal or civil liabilities. It functions as a medical criteria instrument that alters the evidentiary landscape for claims relating to hookworm infection for the described service populations.

This Statement does not itself create duties of payment or procedural obligations such as submission deadlines. It creates binding medical‑criteria guidance that must be used when assessing whether a "reasonable hypothesis" connects hookworm infection or death from hookworm infection to relevant service for claims under section 120A of the VEA or section 338 of the MRCA (section 5). The Repatriation Medical Authority’s role under subsection 196B(2) of the VEA is the statutory authority for making Statements of Principles; accordingly the Authority has the duty to publish and specify the medical factors, and the Statement sets out what factors "must as a minimum exist" to raise the required hypothesis (sections 3 and 9).

For claimants, the rights implicated are evidentiary: a claimant has the right to have their claim assessed against this Statement of Principles. If the claimant can establish that at least one factor in section 9 applies and that the factor is related to their relevant service (section 10(1)), then a reasonable hypothesis of connection is raised. The Statement also clarifies that subsection 9(2) applies only to material contribution or aggravation where the hookworm infection was suffered or contracted before or during, but did not arise out of, the person’s relevant service (section 10(2)). That is a limiting rule that claimants and advisers should note when preparing submissions.

Decision‑makers have the duty to apply this Statement where relevant. Section 11 makes clear that where a factor in section 9 refers to an injury or disease that is covered by another Statement of Principles, the factors in that other Statement apply according to their terms. This imposes a logical duty on adjudicators to cross‑reference Statements and apply them consistently.

The Statement grants no discretion to ignore its factors where applicable; it prescribes the minimum factors that must be present to meet the reasonable hypothesis threshold. It does not specify how weight is to be given to competing medical evidence, nor does it create a procedural appeal mechanism; those matters remain governed by the VEA and MRCA and associated administrative practice, not by this instrument. The Statement also does not authorise particular clinical interventions, and does not impose duties on clinicians beyond the evidentiary role their records and opinions will play in proving the listed factors.

Finally, the Statement includes definitional rights for claim construction: it specifies the species that constitute "hookworm infection" for these purposes (section 7(2)), clarifies that ICD‑10‑AM coding is referenced but subordinate to the statutory definition (section 7(3)), and defines "terminal event" for death claims (Schedule 1). These definitions constrain what counts as the relevant condition and therefore set boundaries for claimants and decision‑makers alike.

The Statement itself contains no penalty provisions and does not create enforcement mechanisms. It is a medical criteria instrument; its declared legal effect is to set the factors needed to raise a reasonable hypothesis connecting hookworm infection, or death from hookworm infection, with relevant service for claims under the VEA and MRCA (sections 5 and 9). It does not direct payments, impose fines, or create criminal liability.

Enforcement, in the sense of ensuring the Statement is applied, is a function of the statutory claims processes under the VEA and MRCA. The instrument is made under subsection 196B(2) of the VEA (section 3), and its practical operation occurs when claims are assessed under statutory provisions referenced in section 5. The Statement does not specify which administrative or judicial body enforces application of the Statement; those procedural enforcement mechanisms are found in the primary statutes and associated regulations and administrative practice, not in this instrument.

Because the Statement defines medical criteria and not sanctions, compliance failures would generally manifest as incorrect claim decisions rather than as discrete offences under the Statement. Any remedies or consequences for misapplication,such as merits review, internal review, or judicial review,are processes provided by the primary legislation and administrative law, and are not set out in this Statement. The instrument also does not prescribe reporting obligations, audits, or compliance monitoring regimes.

In summary, the Statement imposes no criminal, civil or administrative penalties within its text. It exerts legal force through its role as the authoritative medical criteria that decision‑makers must apply in the statutorily prescribed claims processes. The source contains no text establishing enforcement mechanisms beyond that binding role in claims assessment.

The instrument is expressly tied to two statutory regimes: the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. Section 3 states the instrument is made under subsection 196B(2) of the VEA. Section 5 states it applies to claims to which section 120A of the VEA or section 338 of the MRCA applies. The Schedule defines "VEA" and "MRCA" and gives the categories of "relevant service" for each statutory framework (Schedule 1). Therefore the Statement functions as subordinate legislation providing medical criteria that operate within the decision frameworks established by those Acts.

Section 11 creates an interaction rule with other Statements of Principles determined under subsection 196B(2) of the VEA. It provides that where a factor in section 9 refers to an injury or disease covered by another Statement of Principles, the factors in that other Statement apply in accordance with its terms as in force from time to time. This produces a hierarchy and cross‑reference regime among Statements: where overlaps occur, the substantive criteria of the relevant Statement govern that element of the causal analysis. That rule requires decision‑makers to consult and reconcile multiple Statements where factors intersect.

The Statement references ICD‑10‑AM coding as a classificatory aid, noting that while hookworm infection attracts ICD‑10‑AM code B76, for the purposes of this Statement the meaning is the statutory definition in subsection 7(2) (section 7(3)). It therefore limits reliance on diagnostic coding alone, signalling that the statutory text governs over the classification standard for claims assessment. The reference to a particular edition and effective date of the ICD‑10‑AM is specific: the Tenth Edition, effective 1 July 2017 (section 7(3)(b)). That anchors the classification reference to a fixed published edition but confirms the Statement's definition controls.

The Statement repeals the earlier Statement of Principles concerning hookworm disease (No. 7 of 2017) (section 4), which creates a temporal interaction: claims after commencement are to be assessed against the new Statement, and prior claims would have been assessed under the earlier Statement. The instrument does not explicitly state transitional arrangements, but repeal and commencement provisions mean the new wording displaces the old from the commencement date specified (section 2 and section 4).

The Statement does not reference or modify other substantive laws such as public health statutes, occupational health and safety law, workers compensation schemes, or criminal law. Its legal operation is confined to the VEA/MRCA claims nexus and the network of other Statements of Principles determined under subsection 196B(2) of the VEA. Any interface with other regulatory regimes will arise in practice through overlapping factual circumstances but is not addressed in the text.

The instrument contains a limited, concrete amendment history within its own text. It expressly repeals the earlier Statement of Principles concerning hookworm disease (Reasonable Hypothesis) (No. 7 of 2017), Federal Register of Legislation No. F2017L00010 (section 4). The date of the new Statement is recorded as 22 August 2025 (page header and signature block) and its commencement date is 22 September 2025 (section 2). The authority for the instrument is subsection 196B(2) of the VEA (section 3), the same statutory power under which the prior Statement was determined.

No further amendments, variations, or schedules amending other instruments are recorded in the text provided. The Statement does not include an express transitional provision describing how in‑flight claims or appeals are to be treated on repeal of the 2017 Statement. The presence of an explicit repeal means that from 22 September 2025 the 2017 Statement is no longer in force; the instrument therefore represents a complete replacement rather than an amendment to the earlier Statement as published.

The Schedule contains definitions that replace or update the terminology for this subject matter. It reaffirms statutory terms such as "relevant service" and "terminal event", and it enumerates the hookworm species that fall within the definition of "hookworm infection" for this instrument (sections 7(2) and Schedule 1). The ICD‑10‑AM reference is fixed to the Tenth Edition effective 1 July 2017 (section 7(3)(b)), which may be relevant to future amendment considerations if classification systems are updated.

No other historical instruments, earlier drafts, consultation papers, or amendment notes are contained in this text. The instrument itself is self‑contained: it records the date it was signed by the Chairperson of the Repatriation Medical Authority, Professor Terence Campbell AM, on behalf of the Authority, and the formal commencement and repeal actions. For purposes of legal research or administrative practice, any further amendment history or legislative context beyond what is printed here would need to be obtained from official legislative or administrative records, since the instrument does not include that information.

The Statement contains no information about litigation. It names no cases, does not recount judicial decisions, and does not reference tribunal determinations. The text is an administrative medical criteria instrument and does not itself record or summarise litigation concerning either the earlier Statement or claims involving hookworm infection.

The absence of litigation material in the instrument means there is no internal record here of judicial interpretation or appellate gloss on the meaning of its provisions. Practitioners looking for judicial treatment of the 2017 Statement or disputes over the application of Statements of Principles more generally will not find that material in this document. The instrument does not provide examples, illustrative cases, or hypothetical applications that courts or tribunals have considered.

Because the Statement functions as authoritative medical guidance under subsection 196B(2) of the VEA, litigation concerning its application would be litigated through the normal channels applying the VEA and MRCA. The Statement does not itself set procedural rights of appeal or specify the forum for review; those matters lie in the primary legislation and administrative law. Where claimants or decision‑makers seek review of how the Statement has been applied to a particular claim, the Statement is the document to which courts or tribunals would refer, but this instrument contains no recounting of past judicial interactions.

In short, the instrument contains no litigation history, no cited authorities, and no judicial interpretations. Any analysis of litigation risk, precedent or how courts have treated Statements of Principles must be undertaken by reference to external judicial records and is not available from this Statement itself.

This Statement contains several features that have practical and evidentiary consequences for claimants and decision‑makers.

Temporal limitation on exposure evidence: Section 9 requires that exposure to the named hookworm species as described in section 9(1) must have occurred "within the 6 years before clinical onset". That six‑year window is a hard textual constraint in this instrument. Claimants with exposure outside that window will need to rely on different factors or other Statements of Principles, if applicable, because the instrument sets the minimum factors necessary to raise a reasonable hypothesis.

Species and condition scope: The statutory definition of "hookworm infection" is limited to the enumerated species (section 7(2)(a)). That list includes both human and zoonotic species and expressly includes extraintestinal forms such as cutaneous larva migrans (section 7(2)(b) and the accompanying notes). However, the instrument’s scope is the defined species; an infection caused by an organism not listed will not meet the statutory definition for the purposes of this Statement, regardless of ICD‑10‑AM coding. The instrument emphasises that ICD‑10‑AM code B76 is not determinative where the statutory definition differs (section 7(3)).

Linkage to "relevant service": For any factor in section 9 to raise the reasonable hypothesis, it must be related to the person’s relevant service (section 10(1)). This requires a causal or temporal connection between the exposure factor and the person’s relevant service as defined in the Schedule. The instrument does not give examples of what constitutes "related to" relevant service, so claimants must present factual material tying exposure back to their service. Absence of explicit examples creates a potential evidential gap for claims where service records or contemporaneous medical notes are sparse.

Limitation on subsection 9(2): The factor in subsection 9(2) concerning inability to obtain appropriate clinical management "applies only to material contribution to, or aggravation of, hookworm infection where the person's hookworm infection was suffered or contracted before or during (but did not arise out of) the person's relevant service" (section 10(2)). That is a limited application. If the infection arose out of the relevant service, subsection 9(2) does not operate to extend coverage for material contribution or aggravation. Claimants must therefore be careful to identify whether the infection was contracted before, during, or as a result of service.

Interaction with other Statements of Principles: Section 11 requires cross‑application where a section 9 factor refers to an injury or disease covered by another Statement. Practically, this means that overlapping conditions require cross‑referencing and may introduce complexity in multi‑condition claims. Failure to consult relevant Statements could lead to incomplete evidence submissions.

No transitional detail on repeal: The instrument repeals the 2017 Statement (section 4) but contains no transitional provisions. Practitioners should not assume how claims in progress are to be treated on commencement; the text does not specify whether claims initiated under the 2017 Statement continue to be assessed under it or move to the 2025 Statement. That omission is a procedural "gotcha" for case managers and advisers.

Definition of terminal event: The Schedule lists examples of terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) (Schedule 1) but the list is not stated to be exhaustive. However, reliance on that list without addressing whether a claimed terminal event falls within the concept could cause misframing of death claims.

ICD‑10‑AM reference: The instrument ties the ICD‑10‑AM reference to the Tenth Edition effective 1 July 2017 (section 7(3)(b)). If a clinician cites a newer ICD‑10‑AM edition or uses updated coding, the Statement specifies that the statutory definition controls, potentially limiting reliance on updated classification systems.

No penalties or enforcement detail: The Statement sets medical criteria but does not spell out enforcement, remedies or review pathways. Parties expecting procedural guidance or penalty mechanisms will not find them here.

Overall, the "gotchas" are concrete evidential and definitional constraints embedded in the Statement: the six‑year exposure window, species list, requirement that factors be related to relevant service, limited application of the inability‑to‑obtain‑treatment factor, cross‑Statement interaction, repeal without transition detail, and the ICD‑10‑AM anchoring.

Compliance, in the context of this Statement, means preparing and presenting claim evidence that maps to the instrument’s required factors so that a reasonable hypothesis is raised. The Statement requires that at least one of the factors in section 9 must exist and be related to the person’s relevant service (sections 9 and 10(1)). Practitioners and medical advisers should therefore structure evidence to address three discrete elements: (a) the factual existence of the factor, (b) the timing relative to clinical onset, and (c) the relationship of the factor to the person’s relevant service as defined in the Schedule.

1. Document species and diagnosis: Because the instrument defines "hookworm infection" by named species (section 7(2)), clinical records, laboratory reports and pathology results should, where possible, identify the causative species or provide authoritative clinical reasoning tying the diagnosis to a listed species. Where species identification is not possible, medical opinion should address why the clinical picture is consistent with infection by a named species in the Statement and explain diagnostic limitations.

2. Establish exposure within six years of clinical onset: For the exposure factors in section 9(1), evidence should show exposure occurred within the six years before clinical onset. This requires contemporaneous or retrospective accounts of being in contact with contaminated soil/sand, contact with contaminated faeces, ingestion of contaminated food/drink/dust, or presence in tropical/subtropical or warm/damp conditions with poor sanitation (section 9(1)(a)-(e)). Service records, location logs, unit diaries, travel records, and witness statements can supply the factual basis for exposure during service. Clinical onset should be dated precisely in medical records to tie to the six‑year window.

3. Address inability to obtain appropriate clinical management: If relying on subsection 9(2), evidence must show inability to obtain appropriate clinical management before clinical worsening and, per section 10(2), must demonstrate that the infection was suffered or contracted before or during but did not arise out of relevant service. Medical records documenting delayed diagnosis, barriers to access, treatment unavailability, or service medical logistics may be relevant. Expert medical opinion should explain how lack of treatment materially contributed to or aggravated the condition.

4. Tie exposure to relevant service: Section 10(1) requires the factor to be related to the person’s relevant service. Evidence should therefore link the exposure event to the person’s service timeline and circumstances that fit the Schedule’s definition of relevant service. Service classification (operational, peacekeeping, hazardous, British nuclear test defence, warlike, non‑warlike) should be established through service records or official certifications.

5. Consider cross‑referencing other Statements: If a section 9 factor refers to another injury or disease that is the subject of a different Statement of Principles, consult that Statement and gather evidence addressing its factors, as required by section 11. This is particularly relevant where co‑morbid conditions or alternative causal pathways are alleged.

6. Address death claims by documenting terminal events: For claims alleging death was contributed to by hookworm infection, establish that the terminal event enumerated in the Schedule or another terminal event was contributed to by the infection. Medical cause of death documentation, post‑mortem reports, and expert opinion should explain the causal contribution of the hookworm infection to the terminal event (sections 7(4) and Schedule 1).

7. Use ICD‑10‑AM judiciously: The Statement notes the ICD‑10‑AM code B76 but asserts the statutory definition governs (section 7(3)). Where clinicians rely on coding, they should also tie the coding to the statutory species list and provide explanatory opinion where coding alone is insufficient.

8. Prepare expert medical opinion: The Statement sets out the medical conditions and exposure pathways. Expert opinion addressing how the claimant’s factual exposure and clinical course map to the Statement’s factors will be central. Opinions should explicitly reference the Statement’s factors and explain why the required minimum factor exists and is related to relevant service.

9. Preserve contemporaneous evidence: Given the temporal constraints and the reliance on exposure histories, early collection and preservation of service records, medical notes, and witness statements is prudent. The Statement contains no transitional guidance for claims spanning the repeal; practitioners should document which Statement is being relied upon in claims prepared close to the commencement date.

10. Note limitations and plan for cross‑issues: Where the causation is complex or involves co‑existing conditions, plan to address any referenced Statements of Principles and explain how multiple factors combine to meet the reasonable hypothesis threshold.

These steps implement the Statement’s requirements: furnish concrete evidence for at least one factor in section 9, demonstrate it occurred within the statutory time window where applicable, and show it is related to relevant service. The instrument’s text should be cited in submissions to indicate the legal standard being met, specifically sections 7, 9 and 10, and the relevant Schedule definitions.