Statement of Principles concerning mesenteric panniculitis (Balance of Probabilities) (No. 50 of 2018)

Mesenteric panniculitis, for the purposes of this Statement, is an inflammatory condition of the fatty layer underlying the mesentery, omentum and peritoneum that is clinically symptomatic or requires treatment (s 6(2)(a)). The Statement identifies characteristic clinical symptoms (note to s 6(2)): acute or chronic abdominal pain, an abdominal mass or swelling, fever, weight loss, diarrhoea or vomiting, frequently secondary to bowel or mesenteric vessel obstruction. Histological features are also specified in the note to s 6(2): chronic inflammatory infiltration by lymphocytes and macrophages, fat necrosis and fibrosis. The note states diagnosis may be by histology or by abdominal imaging using established radiological criteria (note to s 6(2)).

The instrument expressly excludes a set of other disorders and phenomena from the definition (s 6(2)(b)): sclerosing encapsulating peritonitis, retroperitoneal fibrosis (Ormond disease), peritoneal adhesions, acute peritonitis, infectious peritonitis, and the radiological phenomenon of “misty mesentery” when not specifically diagnosed as mesenteric panniculitis. It also records alternate terminology that may appear in clinical records: mesenteric lipodystrophy or sclerosing mesenteritis (note to s 6(2)). Although it recognises the ICD‑10‑AM code K65.8 is commonly associated with mesenteric panniculitis, it makes clear that the statutory meaning is the one given in subsection 6(2) (s 6(3)-(4)).

On causation, the RMA records its view,based on the medical‑scientific evidence available,that it is more probable than not that mesenteric panniculitis and death from mesenteric panniculitis can be related to relevant service rendered under the VEA or MRCA (s 7). Despite that general view, the Statement imposes a single, narrow connecting factor: inability to obtain appropriate clinical management for mesenteric panniculitis (s 8). That factor must exist before a connection will be drawn on the balance of probabilities. The scope of that factor is constrained: it applies only to material contribution to or aggravation of the condition where the condition was suffered or contracted before or during relevant service but did not arise out of that service (s 9).

The Schedule defines critical terms used throughout: mesenteric panniculitis (referring back to s 6(2)), MRCA, VEA, terminal event and relevant service (Schedule 1). Relevant service is defined narrowly to include types of non‑operational or peacetime service: eligible war service other than operational service, defence service other than hazardous service and British nuclear test defence service, or peacetime service under the MRCA (Schedule 1). Terminal event is defined in the Schedule by way of non‑exhaustive examples (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function).

The instrument affects three principal groups: claimants (veterans and members of the Forces seeking entitlements), medical practitioners and providers of medical evidence, and decision‑makers administering the VEA and MRCA entitlements provisions referenced in s 4.

Claimants: The Statement applies to claims to which section 120B of the VEA or section 339 of the MRCA applies (s 4). The Schedule defines “relevant service” for these provisions as particular categories of non‑operational or peacetime service (Schedule 1). Therefore, claimants who rendered only operational, hazardous or British nuclear test defence service are, by definition, outside the “relevant service” categories established here and will not be able to rely on this Statement for those claims. The Statement also narrows the factual window for claim success: it operates only where the condition was suffered or contracted before or during relevant service but did not arise out of that service (s 9). Put plainly, it targets situations where pre‑existing mesenteric panniculitis may have been materially contributed to or aggravated by lack of access to appropriate clinical management during the period of relevant service.

Medical practitioners and evidence providers: The Statement’s definitional and diagnostic content (s 6(2) and notes) shapes what medical evidence is relevant. Diagnosis must be by histology or established abdominal imaging criteria (note to s 6(2)). Clinical records that simply cite ICD‑10‑AM code K65.8 will not alone determine the statutory meaning, because subsection 6(3) makes the statutory meaning the one in s 6(2) rather than the code (s 6(3)-(4)). Practitioners preparing medical reports for claims should therefore address the elements in s 6(2), including symptomatology, histology/imaging findings, and whether the condition required treatment.

Decision‑makers and administrators: The RMA made the Statement under the statutory power in s 196B(3) of the VEA (s 3). That function feeds into the statutory entitlements regime administered under the VEA and MRCA. Administrators assessing claims under the referenced provisions must apply the RMA’s view and the mandatory factor set out in s 8; they must evaluate whether the claimant experienced an inability to obtain appropriate clinical management and whether the timing of the condition fits the s 9 restriction. Because the Statement sets a single mandatory factor, decision‑makers’ inquiry will focus on the factual question of access to appropriate clinical management and the temporal relationship between disease onset and relevant service.

Other stakeholders: The instrument has indirect effects on insurers, legal advisers and policy analysts working on veterans’ claims, because it narrows the evidentiary focus to access to clinical management and provides a statutory definition that shapes permissible medical characterisations. The instrument does not, however, alter non‑statutory clinical or public health obligations outside the claims context; it is limited to entitlement assessment under the specified statutory provisions (s 4).

Duties and rights in this instrument are expressed indirectly through the mechanism it establishes for entitlement assessments. The RMA’s duty under the VEA to determine Statements of Principles is the source of the instrument (s 3). The immediate operational duty falls on decision‑makers applying the VEA/MRCA provisions referenced in s 4: when considering a claim to which those sections apply, the decision‑maker must apply this Statement’s definitions and the mandatory factor.

Right to rely on the Statement: Claimants who meet the statutory thresholds for claims under section 120B of the VEA or section 339 of the MRCA have the right to have their claim assessed with reference to the RMA’s Statement (s 4). That includes reliance on the RMA’s medical finding that it is more probable than not that mesenteric panniculitis and death from it can be related to relevant service (s 7), subject to the mandatory factor and its temporal limitation.

Mandatory nexus factor duty: The Statement imposes a factual prerequisite for a positive nexus finding: inability to obtain appropriate clinical management for mesenteric panniculitis must exist (s 8). Decision‑makers therefore have the duty to consider evidence establishing whether such inability existed, and whether any inability materially contributed to or aggravated the condition. The instrument does not define “inability to obtain appropriate clinical management”, so decision‑makers retain a duty to make a factual assessment based on the evidence presented and within the administrative framework of the VEA/MRCA claims processes.

Temporal limitation on application: The Statement narrows scenarios in which the mandatory factor can operate. Section 9 provides the duty to limit the nexus finding to cases where the condition was suffered or contracted before or during relevant service and did not arise out of relevant service. That creates a duty on decision‑makers to establish the timing and causal origin of mesenteric panniculitis in each case before applying the factor in s 8.

Diagnostic evidentiary standard: The Statement defines mesenteric panniculitis in s 6(2) and explains acceptable diagnostic methods in the note to s 6(2). There is therefore an implicit duty on medical witnesses to address histological or imaging evidence, and a corresponding right for decision‑makers to require such evidence to apply the definition correctly. The instrument clarifies that reliance solely on ICD‑10‑AM coding is not conclusive because s 6(3) states that, in applying the Statement, the meaning is that given in s 6(2).

No punitive provisions: The instrument contains no offences, penalties or coercive sanctions; it is a declaratory instrument setting out medical principles and a nexus factor for entitlement determinations. It does not create additional regulatory duties outside the claims context, nor does it grant private rights beyond the statutory entitlements framework.

This Statement contains no penalties, offences or administrative sanctions. It is a statutory medical‑evidentiary instrument made under subsection 196B(3) of the Veterans' Entitlements Act 1986 (s 3) and designed for use in determinations under the VEA and MRCA (s 4). Enforcement in the conventional criminal or administrative penalty sense is therefore not a function of the Statement itself.

Practical enforcement occurs through the benefits‑determination process: decision‑makers assessing claims under section 120B of the VEA or section 339 of the MRCA will apply this Statement’s definitions and the mandatory factor when deciding whether the claimant has satisfied the legislative test for connection between mesenteric panniculitis and relevant service (s 4; s 8). If the decision‑maker concludes the factor in s 8 is not established, then under the RMA’s stated approach the claim will not be connected to service on the basis of this Statement. The Statement therefore has a de facto gatekeeping function in benefit administration, but it does not itself prescribe sanctions for non‑compliance.

Appeal and review pathways are outside the text of this instrument. The Statement does not describe merits review, judicial review or appeal mechanisms. Those processes, and any remedies for erroneous application of the Statement, are governed by the VEA and MRCA and associated administrative law frameworks rather than by this instrument. The Statement likewise does not set evidentiary thresholds beyond the ordinary civil standard implied by its title (balance of probabilities) and s 7’s formulation that the RMA is of the view that it is more probable than not that a relationship can exist.

Administrative actors charged with applying the Statement will exercise evaluative judgement when deciding whether appropriate clinical management was unavailable, and whether that unavailability materially contributed to or aggravated the condition (s 8-9). Because the term “inability to obtain appropriate clinical management” is not defined in the Statement, its application necessarily involves fact‑finding and discretion by decision‑makers in the claims process. The Statement provides no enforcement guidance for how to gather, test or verify evidence of lack of access to clinical management; those procedural matters fall to the administrative practice under the VEA/MRCA.

Finally, the Statement is a formal instrument executed under the RMA’s common seal (cover pages), which gives it statutory formality for use by decision‑makers, but it does not itself create an enforcement regime or penalties.

The Statement is a component of the statutory entitlements framework established by the VEA and MRCA. The instrument was made under subsection 196B(3) of the VEA (s 3) and applies to claims to which section 120B of the VEA or section 339 of the MRCA applies (s 4). It therefore interacts with those provisions by supplying the RMA’s medical view and the specific nexus factor decision‑makers must consider when adjudicating relevant claims. The Statement does not amend the VEA or MRCA; it functions as an evidentiary template within their application.

The Schedule cross‑references the VEA and MRCA as defined terms (Schedule 1), and it defines “relevant service” in a way that excludes operational service and certain hazardous services under the VEA, while including peacetime service under the MRCA (Schedule 1). That definitional choice constrains which service histories can be assessed using this Statement. Claims alleging nexus to operational service or to specifically excluded categories of service will not be brought within the scope of this Statement by virtue of the Schedule’s definition of “relevant service”.

On medical classification, the Statement acknowledges the ICD‑10‑AM coding system by identifying K65.8 as the code that commonly attracts mesenteric panniculitis (s 6(3)-(4)), and it provides the full bibliographic reference for the ICD‑10‑AM edition and effective date (s 6(4)). However, it expressly states that, in applying the Statement, the meaning of mesenteric panniculitis is the statutory definition in s 6(2). That means a straight reliance on diagnostic coding in medical records will not suffice for entitlement assessment; the statutory definition , including inclusions and exclusions , controls.

The instrument’s definition of “terminal event” in the Schedule interacts with death‑related provisions in the VEA and MRCA by clarifying what sorts of proximate or ultimate causes of death may be regarded as terminal events contributed to by mesenteric panniculitis for the purposes of a death claim (Schedule 1). Examples listed include pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function. The Statement therefore provides decision‑makers with a taxonomy for assessing whether death was “from” mesenteric panniculitis in the sense required for a contribution finding.

The Statement does not alter or define forensic, coronial or criminal law concepts. Nor does it interact with public health law or clinical negligence law; it is confined to the veterans’ entitlements statutory context. Procedural and remedial interactions , such as merits review, judicial review, or appeals , are governed by the VEA and MRCA and their administrative law regimes and are not addressed in this instrument. The Statement also does not prescribe clinical practice standards; it references diagnostic modalities and clinical symptoms for evidentiary purposes only.

This instrument is recorded as Statement of Principles concerning mesenteric panniculitis (Balance of Probabilities) (No. 50 of 2018). It is dated 27 April 2018 and commences on 28 May 2018 (cover page; s 1-2). The instrument states it was made under subsection 196B(3) of the Veterans' Entitlements Act 1986 (s 3) and bears the Common Seal of the Repatriation Medical Authority (cover pages).

The instrument itself contains no express history of amendments, savings, transitional provisions or links to prior Statements of Principles. It does not record any earlier numbers for the same condition nor any revocations. There are no amending provisions in the text supplied. The Schedule and main body present a self‑contained Statement as at 28 May 2018.

Because the document does not contain amendment or repeal language, any change after commencement would have to be effected by a subsequent RMA instrument made under the same statutory power or by legislative amendment to the underlying Acts. The instrument does not indicate whether it replaced an earlier Statement nor whether subsequent Statements have been issued. Users needing an authoritative current status should check the RMA’s register of Statements of Principles or the Federal Register of Legislation for any later instruments that vary or revoke No. 50 of 2018.

For historical tracking, this instrument’s identification as “No. 50 of 2018” and its commencement date allow researchers to search official sources for subsequent changes. But within the four corners of the text provided there are no recorded amendments, no transitional provisions and no savings clauses.

The Statement itself does not record any litigation history. It contains no references to judicial or tribunal decisions, and it names no cases. The RMA’s written view is expressed as an administrative medical determination made under the VEA power in subsection 196B(3) (s 3, s 7), which is the statutory mechanism by which the RMA informs decision‑makers. The instrument does not comment on precedential application, past claim decisions, or litigious outcomes.

Because the instrument is an administrative determination of medical principles rather than a judicial pronouncement, any litigation concerning the application of this Statement must be identified from external sources, such as decisions of the Administrative Appeals Tribunal, Federal Court or other courts dealing with entitlement appeals under the VEA or MRCA. The text provided contains no report, annotation or citation of such decisions.

For users requiring litigation context , for example to see how tribunals have treated “inability to obtain appropriate clinical management” as a factual nexus factor, or how courts have applied RMA Statements in particular factual matrices , the absence of case references in the Statement means those inquiries must be pursued in case law databases or administrative decision repositories. The Statement itself offers no litigation record, no examples of contested applications, and no discussion of how its definitions have been interpreted in adjudicative processes.

The Statement contains a number of points that commonly produce misunderstanding or evidentiary challenges.

1. Narrow mandatory factor. The only factor that the RMA identifies as sufficient for connection on the balance of probabilities is “inability to obtain appropriate clinical management for mesenteric panniculitis” (s 8). If a claimant cannot establish that inability, the RMA’s Statement provides no alternative connective pathway. That differs from Statements that list multiple potential factors; here the absence of evidence of inability to obtain appropriate management will be decisive against connection under this instrument.

2. Limited timing window. Section 9 restricts application of the factor to cases where the condition was suffered or contracted before or during relevant service and did not arise out of the relevant service. This means: (a) conditions arising out of service are outside the operation of the factor as set in this Statement; and (b) only material contribution to, or aggravation of, a pre‑existing or concurrent condition by inability to obtain management is captured (s 9). Claimants with onset after service or those who can show the condition arose out of service will not fit the precise factual formulation provided here.

3. Clinical definition control. Although the ICD‑10‑AM code K65.8 is recognised, the statutory meaning is the text in s 6(2) rather than the code (s 6(3)-(4)). Medical records which rely solely on coding or use excluded labels (such as retroperitoneal fibrosis or “misty mesentery” not diagnosed as mesenteric panniculitis) will need supporting histological or radiological evidence that matches the statutory definition. The instrument explicitly excludes a number of related disorders (s 6(2)(b)).

4. “Inability to obtain appropriate clinical management” is undefined. The absence of a statutory definition means decision‑makers must make a case‑by‑case factual assessment. That creates evidentiary uncertainty and administrative discretion. Practically, claimants must present documentary evidence of lack of access, refusals, non‑availability or unavailability of proper clinical management, but the Statement does not set boundaries for what constitutes “appropriate” management or which time periods are relevant.

5. Death claims require contribution. Section 6(5) extends mesenteric panniculitis to include death from a terminal event that was contributed to by the person’s mesenteric panniculitis. The Schedule defines “terminal event” by example (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). For death claims, the evidentiary task is dual: establish the contribution of mesenteric panniculitis to the terminal event, and establish the mandatory factor where the conditions of s 9 are relevant.

6. Relevance of service categories. The Schedule’s definition of “relevant service” excludes operational service and certain hazardous categories under the VEA (Schedule 1). Claims based on service types outside the Schedule will not be addressed by this Statement, potentially requiring claimants to rely on other Statements or legal routes.

7. Diagnostic standard reference. The note to s 6(2) prescribes diagnosis by histology or abdominal imaging using “established radiological criteria.” Decision‑makers and practitioners will need to agree on what constitutes the established criteria in any given case. The Statement does not specify which radiological signs suffice, nor does it list acceptable imaging modalities, creating room for contestation.

8. No procedural guidance. The Statement does not provide processes for proving inability to obtain clinical management, nor does it provide required documentary forms, timelines, or evidentiary weightings. Administrative practice under the VEA/MRCA will fill that gap, and outcomes may therefore depend heavily on claim preparation and adjudicator discretion.

These points mean that success under the Statement is fact‑sensitive. The Statement narrows the medical nexus to a single, defined pathway and imposes temporal constraints and diagnostic requirements that may raise proof challenges in marginal cases.

For claimants and their advisers

1. Establish timing and service category. Confirm that the claimant’s service qualifies as “relevant service” under the Schedule: eligible war service (other than operational service) under the VEA; defence service (other than hazardous service and British nuclear test defence service) under the VEA; or peacetime service under the MRCA (Schedule 1). If the service does not fall within these categories, this Statement will not apply (Schedule 1; s 4).

2. Demonstrate the condition fits the statutory definition. Obtain and present diagnostic evidence that satisfies the definition in s 6(2): clinical symptomatology (note to s 6(2)), histology showing chronic inflammatory infiltration by lymphocytes and macrophages with fat necrosis and fibrosis, or abdominal imaging that meets established radiological criteria (note to s 6(2)). Avoid relying only on ICD‑10‑AM code K65.8; the instrument treats the textual definition as the controlling meaning (s 6(3)-(4)).

3. Prove inability to obtain appropriate clinical management. Because s 8 names inability to obtain appropriate clinical management as the mandatory factor, gather contemporaneous records showing lack of access to appropriate care: clinic and hospital notes documenting refused referrals, unavailable specialist services in theatre or posting locations, documented delays in treatment that exhausted reasonable options, Service Medical Authority directives, or other administrative records demonstrating that appropriate management was not available. The Statement does not define the term; therefore, detailed, contemporaneous and specific evidence is likely to be decisive.

4. Show material contribution or aggravation and timing. Under s 9 the inability‑to‑treat factor applies only where the condition was suffered or contracted before or during relevant service and did not arise out of that service. Provide evidence demonstrating the condition pre‑existed or was present during service, and then establish how lack of appropriate management materially contributed to worsening or aggravation. Medical opinion addressing the causal link between lack of care and deterioration will be essential.

5. For death claims, link to terminal event. If seeking entitlement on a death basis, the claimant must show the deceased’s mesenteric panniculitis contributed to the terminal event (s 6(5); Schedule 1 definitions of terminal event). Obtain the death certificate, coronial findings if any, and expert medical opinion explaining the contribution pathway.

For medical practitioners preparing evidence

1. Address the statutory definition explicitly. Structure reports to refer to s 6(2) and to state whether the patient’s presentation meets the elements listed there. Where imaging is used, indicate which radiological criteria were applied and how the images satisfy those criteria. Where histology is available, describe histological features in the terms used in the note to s 6(2).

2. Opine on the effect of lack of management. Provide informed medical opinion on whether inability to obtain appropriate clinical management during the relevant period would, on the balance of probabilities, materially contribute to or aggravate the claimant’s mesenteric panniculitis. If possible, quantify the likely effect or describe the mechanism by which absence of care leads to worsening.

For decision‑makers and administrators

1. Apply the statutory definition and exclusions. Confirm that the condition meets s 6(2) and that none of the excluded conditions listed in s 6(2)(b) are the correct diagnosis. Do not treat ICD coding as determinative; require the medical evidence to speak to the statutory definition (s 6(3)-(4)).

2. Make a focused factual inquiry on inability to obtain appropriate clinical management. Because s 8 frames this as the single requisite factor, allocate resources to assessing the existence, scope, and timing of any inability to obtain appropriate management. Seek documentary evidence such as contemporaneous medical records, unit medical logs, administrative correspondence, or expert medical opinions.

3. Confirm timing and causal origin. Apply s 9 to determine whether the condition was suffered or contracted before or during relevant service and did not arise out of it. If the condition arose out of service, this Statement’s factor does not apply.

4. Seek clarifying expert evidence where necessary. If the medical record is silent on whether lack of treatment would reasonably have materially contributed or aggravated the condition, consider obtaining a clinical opinion that links the absence of management to likely pathological progression.

5. Record reasons carefully. Because the Statement will be used as a basis for acceptance or rejection of claims, ensure reasons explicitly reference the statutory definitions and the presence or absence of the s 8 factor and s 9 temporal constraint.

Implementation risks and administrative burden

The primary compliance burden lies with claimants in proving lack of access to appropriate clinical management and in satisfying the statutory diagnostic definition. Decision‑makers face the practical challenge of making nuanced factual findings on an undefined concept (“inability to obtain appropriate clinical management”) and determining whether that inability materially affected the condition. This creates potential for variability in outcomes depending on the quality of evidence and adjudicator interpretation. To minimise dispute, compile contemporaneous documentary material and detailed medical expert reports that address the statutory elements directly.