Statement of Principles concerning malaria (Reasonable Hypothesis) (No. 25 of 2026)

Reasonable hypothesis. The instrument operates within the legal framework of section 120A of the VEA and section 338 of the Military Rehabilitation and Compensation Act 2004 (MRCA). For claims to which those sections apply, a reasonable hypothesis connecting the disease or death with service is established only if the claim meets the factors set out in the applicable SoP. The hypothesis must be consistent with the SoP factors; if the factors are not satisfied, the hypothesis is not reasonable for the purposes of the legislation.

Malaria. The instrument defines malaria as infection due to one of the human malaria species Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale or Plasmodium malariae, or infection with Plasmodium knowlesi or other simian malaria species. The definition is independent of any ICD‑10‑AM code, although those codes are listed for reference. This is important because the scope of the definition is potentially broader than clinical coding alone might capture.

Relevant service. Defined in the dictionary to include operational service, peacekeeping service, hazardous service, and British nuclear test defence service under the VEA, as well as warlike and non‑warlike service under the MRCA. The instrument applies to claims made by veterans, members of Peacekeeping Forces, members of the Forces under the VEA, and members under the MRCA. The factor must be related to the relevant service rendered by the person.

Factors. The core of the instrument is the list in section 9 of eight factors, each with sub‑conditions. At least one factor must as a minimum exist. Key concepts within the factors include:

• Exposure windows: very specific timeframes between exposure and clinical onset. For P. falciparum, P. malariae, and simian species, the window is at least 4 days but less than 1 year. For P. vivax and P. ovale mosquito bites, the window is at least 4 days but less than 5 years. For percutaneous exposure, transplant, or transfusion of these species, the window returns to 1 year. These differences reflect the biology of the species (dormant liver phase for P. vivax and P. ovale).

• Routes of exposure: mosquito bite, percutaneous exposure (intravenous, intramuscular, subcutaneous, intradermal) to infected blood, solid organ or stem cell or bone marrow transplant, and transfusion of blood or blood products. The note gives examples including contaminated needles, needlestick injuries, and contaminated syringes.

• Inability to access appropriate chemoprophylaxis: a factor that does not require proof of actual infection from a mosquito; rather it requires that the person could not obtain prophylaxis in accordance with contemporary medical standards before clinical onset. This is distinct and potentially easier to establish than proving a specific infective bite.

• Substantially compromised immune system: defined exhaustively by six categories: asplenia (functional or surgical); haematological or solid organ malignancy; HIV infection; severe malnutrition (BMI ≤ 18.5); solid organ, stem cell, or bone marrow transplant; and taking specified immunosuppressive medications (corticosteroids other than inhaled or topical, transplant rejection drugs, tumour necrosis factor‑α inhibitors, and chemotherapeutic agents). This list is closed; other forms of immunosuppression (e.g., from autoimmune disease or biologic therapies not listed) do not count unless they fit the medication categories.

• Pregnancy: within the 6 months immediately preceding clinical onset or clinical worsening. This is a relatively short window.

• Systemic infectious disease trigger for relapse: only for P. vivax or P. ovale, a systemic infectious disease in the 3 months preceding reactivation or relapse of the dormant liver phase. The dictionary defines systemic infectious disease as an infectious disease causing systemic symptoms such as fever, and includes P. falciparum infection and typhoid fever. This means a P. falciparum infection itself can trigger a relapse of P. vivax or P. ovale.

• Clinical worsening: most factors can be used either for clinical onset or clinical worsening, but section 9(4) and section 10(2) limit the clinical worsening aspect to material contribution or aggravation where the malaria was suffered or contracted before or during (but did not arise out of) relevant service. The factor of “inability to obtain appropriate clinical management” applies only to clinical worsening, not onset.

Terminal event. For death claims, malaria must have contributed to a terminal event, defined as pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function. This list is exhaustive; other immediate causes of death may not qualify.

The instrument directly affects veterans, members of Peacekeeping Forces, members of the Forces under the VEA, and members under the MRCA who claim compensation for malaria or death from malaria. This includes both current serving members and former members, as well as their dependents in death benefit claims. The instrument also indirectly affects medical practitioners who provide evidence in support of claims, requiring them to frame their opinions by reference to the defined factors. Decision‑makers within the Department of Veterans’ Affairs (DVA), the Veterans’ Review Board (VRB), and the Administrative Appeals Tribunal (AAT) must apply the SoP as a binding legal instrument. The Repatriation Medical Authority is the maker of the instrument and is affected in its ongoing obligation to review and update SoPs based on emerging medical‑scientific evidence. Legal practitioners and advocates representing claimants must be familiar with the precise wording of each factor, the time limits, and the cross‑references to other SoPs. The instrument does not affect members of the general public or civilian medical practitioners unless they are engaged in the veterans’ compensation system. Because the SoP applies to claims under both the VEA and the MRCA, it has a broader reach than an instrument made solely under one Act. The dictionary defines “relevant service” to include both VEA and MRCA service types, so any person with qualifying service under either framework is within scope.

The instrument does not impose duties in the traditional regulatory sense. Instead, it establishes the evidentiary conditions under which a claimant has the right to have a reasonable hypothesis accepted. The key “duty” is on the claimant or their representative to adduce evidence that raises at least one factor in section 9. That evidence must demonstrate that the factor existed, and that it is related to the person’s relevant service. The decision-maker has a duty to apply the SoP according to its terms. If a factor is established, the reasonable hypothesis is considered raised unless the decision-maker can point to contrary evidence that disproves the hypothesis beyond reasonable doubt (which is a separate step under the VEA). Claimants also have the right to have the SoP applied correctly; misapplication can be grounds for review. There is no duty under the instrument itself on the RMA to explain its reasoning, but the RMA’s power to determine SoPs is subject to judicial review for reasonableness and compliance with the VEA. The instrument gives no rights to third parties or the public. For clinical worsening claims, the instrument imposes a higher threshold: the factor must materially contribute to or aggravate pre‑existing malaria, and the factor itself must be related to service. Claimants have the right to rely on multiple factors if available, but only one needs to be met.

This instrument contains no penalty provisions. It is not a regulatory penal instrument; it is a determinative rule for compensation claims. The practical “penalty” for failing to satisfy the factors is that the claim fails at the reasonable hypothesis stage, meaning the veteran or dependent receives no compensation for malaria. That is a real and significant consequence. Enforcement of the instrument occurs through the claim review process. If a decision‑maker incorrectly applies the SoP, the claimant can seek review by the VRB and then the AAT. The Federal Court can review decisions of the AAT on questions of law, including the interpretation of the SoP. The RMA itself is not subject to penalties for making an SoP that is later found to be invalid, but the instrument can be challenged in the Federal Court by way of judicial review under the Administrative Decisions (Judicial Review) Act 1977 or under the Constitution. The previous 2017 SoP was repealed by this instrument; any claims pending under the old SoP may need to be reassessed under the new one depending on the date of claim and commencement. No criminal penalties or civil pecuniary penalties attach to non‑compliance by any party.

The instrument is made under subsection 196B(2) of the VEA. It applies to claims to which section 120A of the VEA or section 338 of the MRCA applies. This means it governs the reasonable hypothesis standard for those claims, but separate SoPs exist for the reasonable satisfaction standard (made under subsection 196B(3) of the VEA). This SoP does not override the primary legislation; it operates within it. Section 11 of the instrument provides that if a factor in this SoP refers to an injury or disease covered by another SoP, that other SoP applies in accordance with its terms as in force from time to time. For example, factor 9(4)(a) refers to asplenia (functional or surgical), which is a condition that may itself be the subject of a SoP. If a claimant relies on asplenia as the immune compromise factor, the requirements of the asplenia SoP must also be satisfied (unless the asplenia arose from relevant service in a way that does not require a separate SoP). Similarly, factor 9(4)(b) refers to haematological or solid organ malignancy, factor 9(4)(c) to HIV, and factor 9(4)(e) to transplantation. Each of those may have its own SoP that must be considered. The dictionary defines MRCA and VEA, aligning the instrument with both Acts. The instrument also interacts with the Military Rehabilitation and Compensation Act 2004 by defining relevant service to include warlike and non‑warlike service. It does not interact with state workers’ compensation laws or with the Social Security Act 1991, as those are separate systems. The instrument expressly repeals the 2017 malaria reasonable hypothesis SoP, so that earlier instrument no longer has effect. The note to section 8 references “MRCA, relevant service and VEA” and confirms those terms are defined in the dictionary.

This instrument, No. 25 of 2026, is the current version. It repeals the Statement of Principles concerning malaria (Reasonable Hypothesis) (No. 46 of 2017) (F2017L01049). The 2017 SoP was itself preceded by earlier instruments. The RMA determines and revokes SoPs as medical knowledge evolves. The instrument does not record any amendments to itself; it is the original as made. It was made on 20 February 2026 and commences on 23 March 2026. The transitional provisions: the instrument applies only to claims made after the date of commencement, or to claims already in the system that are yet to be determined? Section 5 says it applies to a claim to which section 120A of the VEA or section 338 of the MRCA applies. That includes claims made before commencement but not finally determined, because the relevant sections apply at the time of determination. However, the repeal of the 2017 SoP will affect those claims if they are still pending after commencement. The usual rule under the VEA is that the SoP in force at the time of the decision applies. This instrument changes the applicable factors for any claim decided on or after 23 March 2026.

The source document contains no mention of any litigation history. The instrument itself is only recently made (20 February 2026) and has not yet been the subject of reported decisions. However, previous SoPs for malaria and for other diseases have been extensively litigated. Common grounds of review include whether the RMA failed to consider relevant medical‑scientific evidence, whether the factors are irrational or arbitrary, or whether the interpretation of a factor by a decision‑maker is consistent with the wording. The Federal Court has considered the scope of the RMA’s powers under section 196B, the meaning of “sound medical‑scientific evidence”, and the requirement that factors be based on that evidence. It is reasonable to expect that the 2026 SoP will be tested in future proceedings, particularly regarding the meaning of “inability to access appropriate chemoprophylaxis in accordance with contemporary medical standards” and the exclusion of certain forms of immunosuppression not listed in factor 9(4). The definition of “systemic infectious disease” may also be litigated, especially its inclusion of Plasmodium falciparum infection for the purpose of triggering relapse of P. vivax or P. ovale. The instrument does not cite any case law, and no cases are referenced in the dictionary.

Several provisions in the instrument can easily trap the unwary.

Time windows are species‑specific and route‑specific. A claimant who contracted P. vivax from a mosquito bite has a 5‑year window from exposure to clinical onset. But if the same species is contracted via blood transfusion, the window collapses to less than 1 year (factors 9(1) and 9(3)). If the species is unknown, the decision‑maker may need evidence to identify it, or fall back on the shortest window.

The immune compromise list is exhaustive but medically incomplete. Factor 9(4) lists specific categories. A person on rituximab for rheumatoid arthritis is not covered unless the drug falls within one of the listed medication classes (it does not, though it is an immunosuppressant). A person with an autoimmune disease like lupus but not on listed drugs is not covered unless they meet another category (e.g., severe malnutrition). The BMI threshold for severe malnutrition is ≤ 18.5 kg/m², which is low but not unusual. The instrument requires “severe malnutrition” to be present; a low BMI alone may not satisfy the clinical definition.

Inability to obtain appropriate chemoprophylaxis is not the same as failure to take it. The factor is about access, not compliance. A person who was deployed to a malarious area but was not issued prophylaxis because of supply failure or medical contraindication may qualify. But a person who was issued prophylaxis and chose not to take it will not qualify under this factor. The standard is “contemporary medical standards”, which may change over time; a claimant must show that the prophylaxis was appropriate at the time and that it was not accessible.

The clinical worsening provisions are narrow. Section 9(8) (inability to obtain appropriate clinical management before clinical worsening) and the application of other factors to clinical worsening are limited by section 10(2): they apply only where the person’s malaria was suffered or contracted before or during (but did not arise out of) the person’s relevant service. If the original malaria arose from service, clinical worsening does not need a separate SoP factor (it would be accepted as part of the original claim). But if the malaria was pre‑existing or contracted in non‑service circumstances, the factor must be related to service and must materially contribute to the worsening.

Relapse of P. vivax or P. ovale requires a specific trigger. Factor 9(7) only applies if there was a systemic infectious disease within the preceding 3 months. That includes P. falciparum infection itself. But if the relapse occurs without any identified systemic infection, the factor does not apply. Claimants cannot rely on the mere passage of time or unspecified stress.

Terminal event definition is closed. For death claims, the terminal event must be one of the five listed. If the immediate cause of death is something else (e.g., renal failure, multi‑organ failure, septicaemia not listed), the claim may fail unless that cause can be characterised as one of the listed events. “Respiratory failure” is listed but “renal failure” is not. Practitioners should check whether the terminal event fits the dictionary.

Cross‑reference to other SoPs. Section 11 means that if a factor involves a disease that itself has a SoP (e.g., HIV, malignancy), the claimant must satisfy that SoP as well. This can multiply the evidentiary burden.

Dates and timing. The instrument uses “clinical onset” and “clinical worsening” as separate concepts. For factors that refer to “clinical onset”, the factor must exist before or at the time of first symptoms. For factors that refer to “clinical worsening”, the factor must exist at the time of worsening. The pregnancy factor (9(6)) allows both onset and worsening. The chemoprophylaxis factor (9(3)) only mentions “clinical onset”, so it cannot be used for worsening.

For a claimant or their representative, compliance means gathering evidence that matches at least one factor exactly. The first step is to identify the malaria species if possible, as the relevant factor depends on whether the species is P. falciparum, P. malariae, simian species, or P. vivax/ P. ovale. If the species is unknown, the most restrictive timeframes (1 year for most exposure routes) will likely apply, though decision‑makers may need to assume the worst case. For mosquito‑borne infection, the claimant must establish the date of the mosquito bite (or at least a credible period of exposure in a malarious area) and the date of clinical onset. Service records showing travel to endemic areas, together with medical records documenting the date of symptoms and diagnosis, are essential. For percutaneous exposure, transplant, or transfusion, the specific incident must be documented. For the chemoprophylaxis factor, evidence that prophylaxis was not available (e.g., service orders, supply records, medical officer notes) and that it would have been appropriate according to contemporary standards (e.g., guidelines issued by the Australian Defence Force or the World Health Organization at the time) is needed. For immune compromise, a diagnosis of one of the listed conditions or prescription of a listed medication must be in the medical records; the timing relative to clinical onset must be clear. For pregnancy, a dated pregnancy test or antenatal record is necessary. For relapse of P. vivax or P. ovale, evidence of a systemic infectious disease within 3 months before relapse is required; the definition includes the specific serology or diagnosis of that infection. For clinical worsening, the original malaria must be shown to have been contracted outside service (or before service), and the worsening factor must be related to service (e.g., inability to obtain clinical management because of posting to a remote location). Representatives should also check whether any factor refers to another SoP and ensure that the conditions of that SoP are met or that an exemption applies (e.g., asplenia from service may be accepted without a separate SoP if it arose directly from service). The claim must be lodged with DVA with all supporting evidence. If the claim is refused because the factors are not met, the decision should be reviewed to ensure the instrument was correctly interpreted, particularly regarding time windows, species identification, and the definition of “related to service”. The SoP should be cited in the claim and submissions. Medical experts should be briefed on the precise wording of the factors to avoid giving opinions that do not match the instrument. Keeping a copy of the instrument as at the date of decision is important because the SoP may be amended after the claim is lodged.