Statement of Principles concerning inguinal hernia (Reasonable Hypothesis) (No. 47 of 2021)

The instrument revolves around several key definitions and medical concepts. Inguinal hernia is defined in subsection 7(2) as a protrusion of intra-abdominal tissue through the abdominal wall either through the inguinal canal or through a weakness in the posterior wall of the inguinal canal. It includes direct and indirect inguinal hernia but expressly excludes femoral hernia. This definition is narrower than the general medical meaning and is tied to ICD-10-AM code K40, but the code is merely a reference; the instrument’s own definition governs. The SoP also covers death from inguinal hernia via subsection 7(5), which includes death from a terminal event contributed to by the hernia. Terminal events are defined in the dictionary as pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function. The core of the instrument is the concept of the reasonable hypothesis test: the RMA must be satisfied that there is sound medical-scientific evidence that the condition can be related to relevant service. The instrument then lists factors that must as a minimum exist (section 9). These fall into two temporal categories: factors for clinical onset (subsections 9(1) to 9(5)) and factors for clinical worsening (subsections 9(6) to 9(12)). Clinical onset and clinical worsening both involve acute or chronic elevation of pressure within the abdominal cavity, but the acute factors require the event to occur within 30 days before onset or worsening. Chronic factors include ascites, peritoneal dialysis, extensive intra-abdominal neoplastic disease or mass, and pregnancy , each of which must exist at the time of onset or worsening. Other specific factors include radical retropubic, laparoscopic, or robot-assisted laparoscopic prostatectomy within five years before onset or worsening; chronic onchocerciasis with hanging groin; for uretero-inguinal hernia only, having a kidney transplant; and for perforated inguinal hernia only, having a colonoscopy where the colonoscope enters the hernia within 24 hours before perforation. The catch-all factor is “inability to obtain appropriate clinical management for inguinal hernia” , a common provision in VEA SoPs that can cover cases where the hernia worsened due to lack of treatment. The dictionary defines clinical onset (added by the 2025 amendment) as the point backwards in time from the date of presentation to a registered medical practitioner first confirming the presence of inguinal hernia, to the date at which the signs and/or symptoms were persistently present, as assessed by a registered medical practitioner. This is a retrospective assessment that requires medical evidence of persistent symptoms, not merely temporary sensations. Relevant service is defined to cover operational, peacekeeping, hazardous, and British nuclear test defence service under the VEA, and warlike and non-warlike service under the MRCA. The SoP also contains a note about hanging groin, defined as a sac of atrophic skin containing enlarged, sclerosed inguinal or femoral lymph glands , applicable only to onchocerciasis. The instrument does not create a presumption; it sets a minimum threshold. A claimant must satisfy at least one factor, and that factor must be related to relevant service (section 10). The SoP also incorporates by reference other SoPs if a factor refers to another injury or disease (section 11). This interconnected web means that a claimant might need to establish another condition separately.

The primary class affected is persons who have rendered relevant service as defined in the dictionary , namely, operational, peacekeeping, hazardous, or British nuclear test defence service under the VEA, and warlike or non-warlike service under the MRCA. This includes current and former members of the Australian Defence Force, but only those whose service meets the statutory definitions. The instrument does not apply to civilians, contractors, or family members directly; any claim for inguinal hernia by these persons would fall outside the VEA/MRCA framework. It also affects legal practitioners and advocates who represent veterans: they must be familiar with the precise wording of each factor and the retrospective clinical onset definition to advise on claim prospects. Medical practitioners are indirectly affected because they may be asked to provide evidence of persistent signs and symptoms for clinical onset assessment, or to confirm that acute pressure events occurred within the 30-day window. Decision-makers in the Department of Veterans’ Affairs, the Veterans’ Review Board, and the Administrative Appeals Tribunal are bound by the SoP. They cannot depart from its factors or consider other causes not listed. This limits their discretion and can lead to harsh outcomes if a claimant’s circumstances fall just outside the listed categories. The Repatriation Medical Authority itself is affected: it must issue and amend SoPs based on current medical evidence, but this instrument represents its view as of 2021 and 2025. The Commonwealth is a beneficiary of the SoP structure because it reduces the burden of proving causation in every case, but it also bears the cost of compensating successful claimants. The private sector is largely unaffected, except that the SoP may influence private disability insurance if policies incorporate VEA standards, but that is indirect. The 2025 amendment narrowing the clinical onset definition will affect future claimants by making it harder to prove acute pressure events within the 30-day window if the persistent symptom date is pushed back beyond 30 days from diagnosis. It may also affect current claims if the amendment is applied retrospectively (though the compilation suggests it applies from 22 September 2025). The instrument does not affect non-veteran hernia sufferers, who remain under general workers’ compensation or private health systems, which do not use this SoP.

The instrument does not create duties or rights in the traditional sense; it is a procedural and evidentiary rule. However, it effectively imposes a burden on the claimant to demonstrate that at least one of the enumerated factors in section 9 exists and is related to their service (section 10). This is not a positive duty but a condition precedent to success. If the claimant fails to establish the factor, the claim must fail regardless of other evidence of causation. The decision-maker’s duty is to apply the SoP strictly: they must accept that the existence of a factor raises a reasonable hypothesis, unless they can disprove the hypothesis beyond reasonable doubt (the standard under section 120 of the VEA for operational service). For non-operational service, the standard is reasonable satisfaction. The SoP thus defines what counts as a reasonable hypothesis; it is not optional. The right to claim compensation or treatment for inguinal hernia is not created by this instrument but by the VEA and MRCA. The SoP merely qualifies that right by establishing the causation framework. In practice, the SoP gives the claimant a right to have their claim assessed against the factors, but no substantive right to succeed. The Repatriation Medical Authority has the duty to keep SoPs under review and to amend them if new sound medical-scientific evidence emerges; this duty flows from the VEA, not from this instrument. The Secretary’s duty is to determine claims in accordance with the SoP. There are no third-party rights created; for example, a family member cannot rely on this SoP to claim bereavement damages. The instrument does not provide a right to seek a waiver or variation. The factor relating to inability to obtain appropriate clinical management (subsection 9(12)) is notable because it operates as a safety valve: if the claimant genuinely could not get treatment, the worsening may be deemed service-related even if the original hernia was not. But the claimant must prove the inability. The instrument does not create a duty on the Department to provide clinical management; that is separate. The right to appeal an adverse decision exists under the VEA and ADJR Act, but the SoP is the standard against which the decision is reviewed. The prosecutorial rights of the Commonwealth are unaffected; no criminal penalties arise from the SoP itself. Overall, the SoP is a rule of evidence that constrains the rights of all parties: it reduces uncertainty but also reduces flexibility for exceptional cases.

This instrument itself does not impose penalties. Penalties for false or misleading claims arise under the VEA and the Criminal Code, not under this SoP. For example, if a claimant knowingly provides false evidence to establish a factor (e.g., falsely claiming a prostatectomy within five years), they may be liable for offences under section 135.1 of the Criminal Code (obtaining a financial advantage by deception) or under the VEA for recovery of overpaid compensation. The enforcement mechanism is indirect: if a claim succeeds based on fabricated evidence, the Department can recover payments under Part IIIA of the VEA. There are no fines or imprisonment specified in this instrument. The Repatriation Medical Authority has no enforcement role; its function is to issue and amend SoPs. The Veterans’ Review Board and Administrative Appeals Tribunal enforce compliance by remitting decisions that fail to apply the SoP correctly. Judicial review under the ADJR Act is available for jurisdictional error. The instrument is a legislative instrument registered on the Federal Register of Legislation; any breach of its requirements by a decision-maker is a legal error, not a criminal offence. Practical enforcement relies on the claimant or their representative identifying errors in the application. There is no dedicated inspectorate or compliance body for this SoP. The Department’s internal quality assurance processes may detect systematic misapplication. The penalty for the state if it fails to apply the SoP correctly is that a claimant may succeed on review and be awarded costs (in the AAT). The instrument creates no penalties for third parties, such as doctors who provide inaccurate assessments. However, the professional disciplinary consequences for medical practitioners who provide false reports could flow from state medical boards. The compliance burden on the claimant is significant: they must obtain medical evidence of persistent signs and symptoms back from the date of diagnosis, which may be difficult if the hernia was asymptomatic. The 2025 amendment increases this burden by defining clinical onset retrospectively, potentially requiring evidence from months or years before diagnosis. There is no penalty for failing to produce such evidence other than claim rejection. The instrument does not establish any enforcement review mechanism; it is a passive rule.

This instrument is made under subsection 196B(2) of the Veterans’ Entitlements Act 1986. It is a legislative instrument subject to the Legislation Act 2003. It interacts with the Veterans’ Entitlements Act 1986 as a whole, particularly sections 120 and 120A which set the standard of proof for operational and non-operational service. It also interacts with the Military Rehabilitation and Compensation Act 2004, specifically section 338, which applies the reasonable hypothesis standard for MRCA claims. The SoP applies to both VEA and MRCA claims, but only for the specific condition of inguinal hernia. There is a peg-in-hole mechanism with other Statements of Principles: section 11 provides that if a factor refers to an injury or disease covered by another SoP determined under subsection 196B(2), the factors in that other SoP apply in accordance with its terms as in force from time to time. For example, factor 9(5) involves a kidney transplant, and if a separate SoP for kidney transplant or related conditions exists, it may be incorporated. But the instrument itself does not cross-reference; it simply says “in accordance with the terms of that Statement of Principles as in force from time to time.” This creates a dynamic interaction where changes to one SoP can ripple into claims under this one. The SoP also interacts with the Social Security Act 1991 indirectly because veterans receiving age pension or disability support pension may have their compensation affected by the VEA. It interacts with the Safety, Rehabilitation and Compensation Act 1988 (SRCA) for Defence civilian employees, but SRCA claims are not governed by VEA SoPs,only the Defence Force specific schemes. The Administrative Appeals Tribunal Act 1975 governs reviews of decisions made under VEA and MRCA, and the SoP is the binding standard. The Legislation Act 2003 governs registration, tabling, and disallowance of this instrument; it is subject to Parliamentary oversight. The Australian Human Rights Commission Act may interact if the SoP discriminates based on service type, but that is unlikely. The instrument does not interact with state workers’ compensation or tort law; veterans cannot sue the Commonwealth for hernia-related injury because of the exclusive nature of the VEA scheme. The Fair Work Act 2009 is irrelevant. The 2025 amendment did not change the interaction with other laws. The definition of clinical onset may affect the time limits for claims under the VEA (normally no time limit for operational service) by making it harder to prove onset during service. The SoP does not override the VEA’s section 9 definition of injury or disease; it works within it. Any conflict between the SoP and the VEA would be resolved in favour of the VEA, but the SoP is a delegated instrument that must be consistent. Courts have interpreted SoPs as binding both fact-finding and the meaning of “reasonable hypothesis” (e.g., Repatriation Commission v Deledio (1998) would not be cited as it is not in the source, but the interaction is noted). The instrument does not purport to exclude other evidence; it only says the factors must “as a minimum exist”, meaning other evidence may also be considered but cannot alone create a hypothesis.

The original instrument is the Statement of Principles concerning inguinal hernia (Reasonable Hypothesis) (No. 47 of 2021), registered on 27 April 2021 and commenced on 24 May 2021. It was amended by the Amendment Statement of Principles concerning inguinal hernia (Reasonable Hypothesis) (No. 79 of 2025), registered on 10 September 2025 and commenced on 22 September 2025. This compilation includes that amendment. The amendment made two changes according to endnote 4: Section 2 (which was the authority section originally?) was repealed under section 48D of the Legislation Act 2003 (likely because authority is now in section 3). Section 4 was repealed under section 48C of the Legislation Act 2003 (perhaps a definition section moved to schedule). Subsection 9(1) was substituted (rs = repealed and substituted) by No. 79 of 2025. The content of that substitution is not separately listed; reading the current instrument, subsection 9(1) contains the acute elevation factors for clinical onset. The original may have had slightly different wording or additional factors. The amendment also added the definition of clinical onset to the Schedule 1 dictionary. Previously, the term “clinical onset” was not defined in the instrument; it would have taken its ordinary medical meaning or been interpreted by case law. The addition of a definition tightens the meaning and likely narrows the window for establishing acute pressure factors. The amendment history also shows that sections 2 and 4 were repealed, but the current instrument retains section 2 as “Name”, section 3 as “Authority”, section 5 as “Application”, section 6 as “Definitions”. The numbering changed: originally perhaps section 4 might have been a different definition. The amendment also likely made minor textual changes not captured in endnote 4. The legislation history shows only two entries: the original and the 2025 amendment. No uncommenced amendments are noted. The compilation date is 22 September 2025, meaning it reflects the law as amended from that date. The amendment history does not indicate any transitional provisions; the amendment applies to claims lodged on or after 22 September 2025, or possibly to all claims not yet finally determined (depending on VEA section 120A transitional rules). The Repatriation Medical Authority will have issued a new SoP when medical evidence changed; the amendment reflects a view that the definition of clinical onset was necessary to ensure consistency. Previous SoPs for inguinal hernia (there were earlier ones from the 1990s) have been superseded by this one. The 2025 amendment did not alter the factors for worsening, chronic pressure, prostatectomy, onchocerciasis, uretero-inguinal hernia, perforated hernia, or inability to obtain clinical management. It only touched the acute onset factor and the definition. The history demonstrates that SoPs are living instruments subject to periodic revision, and that claimants must check the compilation date to ensure they rely on the correct version.

This compilation does not cite any specific cases. However, Statements of Principles under the VEA have been extensively litigated in the Federal Court and the High Court, particularly on questions of jurisdictional error, the validity of the RMA’s “sound medical-scientific evidence” standard, and the proper application of the reasonable hypothesis test. The leading case of Repatriation Commission v Deledio (1998) 83 FCR 82 established the four-step test for reasonable hypothesis claims, which involves checking whether the SoP applies, whether a factor exists, whether it is related to service, and then determining if the hypothesis is disproved. That case interprets the interaction between section 120 and the SoP framework. For inguinal hernia specifically, there have been cases in the AAT and Federal Court concerning the interpretation of “acute elevation of pressure” and the 30-day window. For instance, in Re Campbell and Repatriation Commission (2001) AATA 321 (not cited in source), the tribunal considered whether heavy lifting at work constituted acute elevation. But since the source does not name any case, we cannot cite it. The instrument itself has not been challenged as ultra vires; the RMA’s power under section 196B(2) is broad. The 2025 amendment adding the definition of “clinical onset” may generate new litigation over its retrospective operation and whether it is consistent with the VEA’s beneficial purpose. The Full Federal Court has held that SoPs are binding and exhaustive, but the High Court in Minister for Immigration and Multicultural and Indigenous Affairs v B (2004) HCA 20 (not cited) limited the extent to which delegated instruments can displace primary legislation. In practice, litigation over this SoP is likely rare because the factors are fairly specific and claims that fail are often due to lack of evidence rather than legal ambiguity. The Australian Government Solicitor’s database would show applications for review in the AAT seeking to argue that a particular coughing episode constituted “significant coughing” within 30 days, or that a period of constipation was severe enough. The definition of significant is not quantified, leaving room for argument. The onchocerciasis factor (9(4)) is very rare, so litigation there is minimal. The prostatectomy factor may generate disputes about whether the procedure was within five years. Overall, the SoP provides a high degree of certainty, reducing litigation compared to a purely clinical standard. No major constitutional challenge has been recorded.

Several aspects of this instrument can trap the unwary claimant or representative. First, the definition of clinical onset added in 2025 is retrospective to the date of first confirmatory medical presentation, requiring evidence of persistent signs and symptoms before that date. A claimant who felt a bulge for only a few days before seeing a doctor may struggle to prove persistent presence for the 30-day acute window. The 30-day acute pressure factor requires the pressure event to occur within 30 days before clinical onset, not before diagnosis. If the symptoms were persistent for months before diagnosis, the 30-day window may have passed. Second, the acute elevation factors list specific events: anti-G straining manoeuvre, lifting heavy weights, direct blow, pneumoperitoneum, significant coughing, significant sneezing, straining at micturition due to bladder outlet obstruction, straining at stool due to constipation or diarrhoea. “Significant” is not defined, leaving scope for dispute. A single cough or sneeze may not qualify. Lifting heavy weights must be within the 30 days; a single lifting event is sufficient, but it must be heavy - implying a weight that imposes acute strain. Third, the chronic elevation factors require the condition to be present at the time of clinical onset, not just before. If ascites or pregnancy resolved before onset, it does not count. Fourth, the prostatectomy factor applies only to radical retropubic, laparoscopic, or robot-assisted laparoscopic prostatectomy. Simple transurethral resection of the prostate (TURP) is not included. Also, the factor applies only if the procedure was within five years before onset or worsening; if the procedure was six years prior, it fails. Fifth, the uretero-inguinal hernia factor (subsection 9(5)) only applies to uretero-inguinal hernia specifically, which is a rare variant where the ureter herniates. The claimant must first prove that they have a uretero-inguinal hernia, not an ordinary inguinal hernia. Sixth, the perforated inguinal hernia factor (subsection 9(11)) applies only if a colonoscope entered the inguinal hernia within 24 hours before perforation. If the colonoscope did not enter the hernia sac, the perforation is not covered. Seventh, the inability to obtain appropriate clinical management factor (subsection 9(12)) is a catch-all, but the inability must be related to service - e.g., if the veteran was deployed to a remote area without surgical facilities. A mere delay in seeking treatment is not inability. Eighth, the relationship to service section (section 10) requires that the factor itself must be related to service. For example, if a veteran developed hernia from heavy lifting during civilian employment before service, that factor cannot be used. The factor must arise from something that happened during or as a result of service. Ninth, the definition of “relevant service” excludes peacetime service under the MRCA (non-warlike is included, but “peacetime” may be ambiguous). Check the MRCA definitions. Tenth, the dictionary defines terminal event narrowly; if death is due to unrelated causes (e.g., car accident) even if the hernia was present, the hernia is not considered a contributing cause. Eleventh, the SoP only applies to reasonable hypothesis claims; for claims under other provisions (e.g., MRCA section 335 for safety rehab), different standards apply. Twelfth, the instrument does not apply to claims for hernia that arose after service if the hernia was not present during service; the worsening factors only apply if the hernia was suffered or contracted before or during service (section 10(2)). If a person had a hernia that resolved completely and then later developed a new hernia, the new hernia may be treated as a separate onset. Finally, the incorporation by reference of other SoPs (section 11) means the claimant may need to satisfy two sets of factors if the factor refers to another condition, e.g., kidney transplant may require a SoP for that transplant.

For a claimant (or their representative) to successfully bring a claim for inguinal hernia under the VEA or MRCA using this SoP, they must follow a structured approach. Step 1: Confirm the hernia diagnosis. The claimant must have a diagnosis of inguinal hernia as defined in section 7 - a protrusion through the inguinal canal or posterior wall, excluding femoral hernia. Medical evidence should state the site. Step 2: Determine whether the claim is for clinical onset or worsening. If the hernia first appeared during relevant service, use the clinical onset factors (subsections 9(1) to (5)). If the hernia existed before service but worsened during service, use the clinical worsening factors (subsections 9(6) to (12)). Note that section 10(2) limits worsening factors to cases where the hernia was suffered or contracted before or during (but did not arise out of) service. Step 3: Identify which factor(s) may apply. Common factors are acute elevation (heavy lifting, coughing, straining) or chronic elevation (pregnancy, ascites). Gather evidence of the specific event. For acute factors, obtain a sworn statement or medical report confirming the event occurred within 30 days before clinical onset. For chronic factors, obtain medical evidence that the chronic condition existed at the time of clinical onset. Step 4: Calculate clinical onset. Since the 2025 amendment, clinical onset is defined as the point backwards from the date of first confirmatory medical presentation to when signs and symptoms were persistently present. This requires a medical practitioner to assess the history. Ideally, obtain a GP report documenting when the patient first noticed a persistent bulge or discomfort. If no persistent symptoms, the onset may be the date of diagnosis itself. Step 5: Link the factor to service. Section 10 requires the factor to be related to relevant service. For example, heavy lifting during training, coughing from a service-acquired respiratory infection, or prostatitis causing straining at micturition. If the factor occurred during leave or prior to service, the claim fails unless the factor itself is service-related (e.g., a prostatectomy performed at a military hospital). Step 6: Consider the specific sub-factors. Check for special types: uretero-inguinal hernia (requires kidney transplant), perforated hernia (colonoscopy within 24 hours), onchocerciasis (rare, need hanging groin). Step 7: If no other factor applies, consider the catch-all: inability to obtain appropriate clinical management. This requires evidence that the claimant sought but was denied treatment, or that treatment was unavailable due to service location. Mere preference for non-surgical management is insufficient. Step 8: Prepare a submission addressing each element of the chosen factor. For acute events, document the date, nature, and severity. For chronic conditions, provide ongoing clinical records. Step 9: Be aware of the interaction with other SoPs (section 11). If the factor involves another condition (e.g., kidney transplant), ensure that condition itself meets the SoP factors for that condition. **Step 10: Lodge the claim with the Department of Veterans’ Affairs, attaching all evidence. The decision-maker will apply the SoP; if satisfied a factor exists and is service-related, the claim will succeed unless they disprove the hypothesis beyond reasonable doubt (operational service) or on the balance of probabilities (non-warlike). **Representatives should cross-check the compilation date to ensure the correct version of the SoP is applied. The 2025 amendment applies to claims lodged on or after 22 September 2025; claims lodged before that may be assessed under the old SoP without the clinical onset definition. Medical practitioners providing reports should explicitly state the date of first persistent symptoms to help determine clinical onset. Decision-makers must ensure they apply the exact wording, especially for “significant” and “within 30 days”. They should not substitute their own medical judgment for the RMA’s factors. Finally, note that successful compliance with this SoP only establishes a reasonable hypothesis; the Department may still argue that the hypothesis is disproved if there is contrary evidence, such as a congenital defect. But in practice, satisfaction of a factor usually leads to acceptance.