Statement of Principles concerning schistosomiasis (Balance of Probabilities) (No. 62 of 2019)

The instrument organises around a small set of legal and medical concepts that will be used by decision makers when assessing claims. These concepts are defined in the body and in Schedule 1 and include: schistosomiasis, death from schistosomiasis (including terminal events), relevant service, and the qualifying factors that, if established and linked to relevant service, satisfy the causal connection on the balance of probabilities.

Schistosomiasis, as defined for legal purposes in subsection 7(2), means infection by a Schistosoma species specifically enumerated (S. mansoni, S. haematobium, S. japonicum, S. intercalatum, S. mekongi, S. malayensis and S. guineensis). The definition explicitly "includes the acute and chronic symptoms and signs caused by the Schistosome worms or eggs" (s 7(2)(b)). The Statement adds clinical timing notes: acute schistosomiasis usually occurs two to 12 weeks after exposure and may feature symptoms such as urticaria, cough, fever, malaise, myalgia and diarrhoea; chronic schistosomiasis may develop months to several years after exposure and can affect a wide range of organ systems (s 7, notes 1 and 2). The Statement also notes the ICD‑10‑AM code B65 for schistosomiasis but instructs that the statutory meaning is the definition in subsection 7(2) (s 7(3)‑(4)).

"Death from schistosomiasis" is defined to include death from a terminal event or condition that was contributed to by the person's schistosomiasis; the Schedule supplies an express list of terminal events such as pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (Schedule 1, terminal event definition). This means that the legal notion of death from schistosomiasis reaches proximate and ultimate causes where schistosomiasis materially contributed to the terminal event (s 7(5); Schedule 1).

Relevant service is defined in the Schedule to include several statutory categories: 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, and peacetime service under the MRCA (Schedule 1). The instrument applies to claims to which s 120B of the VEA or s 339 of the MRCA apply (s 5). The RMA states that, on the sound medical‑scientific evidence available, it is more probable than not that schistosomiasis and death from schistosomiasis can be related to relevant service (s 8); that statement sets the evidentiary posture and confirms the balance of probabilities standard.

The Statement sets three alternative "factors that must exist" for a positive connection on the balance of probabilities: cutaneous or mucosal contact with water containing Schistosoma larvae within the 30 years before clinical onset (s 9(1)); a solid organ transplant where the organ is infected with a specified Schistosoma species within one year before clinical onset (s 9(2)); and inability to obtain appropriate clinical management for schistosomiasis (s 9(3)). Notes and subclauses expand on the first factor by listing types of contact (swimming, wading, washing in, drinking contaminated water) and by describing environmental conditions where larvae are most likely (minimal human waste disposal, high likelihood water contaminated with faeces and urine) (s 9 notes).

Finally, cross‑reference mechanics are explicit: if a factor in s 9 refers to an injury or disease covered by another Statement of Principles determined under s 196B(3) of the VEA, then the factors in that other Statement apply according to its terms as in force (s 11). This creates a system in which overlapping etiologies are resolved by applying the relevant other SoP.

The instrument affects claimants and decision makers within the veterans' and defence compensation systems to which the VEA and the MRCA apply. The instrument itself "applies to a claim to which section 120B of the VEA or section 339 of the MRCA applies" (s 5). That language means the Statement functions as the RMA's determination of the medico‑legal principles to be applied when assessing whether schistosomiasis or death from schistosomiasis is connected with a claimant's relevant service. It does not create new entitlement categories in isolation; rather it provides the causation framework invoked under those claim provisions.

Who decides: the Repatriation Medical Authority is the statutory author of the Statement, acting under subsection 196B(3) of the VEA (s 3). The RMA sets the Statement, including the definition of schistosomiasis, the qualifying factors, and the medical‑scientific basis statement (s 8). Administrative decision makers who adjudicate claims under s 120B VEA or s 339 MRCA will apply this Statement in assessing causation. The instrument itself does not specify who pays compensation or how benefits are allocated; those matters remain within the VEA and MRCA frameworks referenced (s 5).

Who must provide evidence: claimants seeking acceptance that schistosomiasis or death from schistosomiasis is connected with their relevant service will need to establish that at least one of the factors in section 9 exists and that the factor is related to their relevant service (s 9; s 10(1)). For example, a claimant whose service included exposure to freshwater in an endemic area will need to link that exposure to the required 30‑year window before clinical onset (s 9(1)). A claimant relying on the transplant factor will need to show that an organ transplant infected with one of the specified Schistosoma species occurred within the one year before clinical onset of schistosomiasis (s 9(2)). A claimant relying on inability to obtain appropriate clinical management will need to show that the disease was suffered or contracted before or during, but did not arise out of, the person's relevant service if they seek to establish material contribution or aggravation under s 10(2) and s 9(3).

Secondary effects: the instrument affects medical advisers, expert witnesses and case managers because the Statement provides a legal definition and evidentiary triggers that experts must address in reports , for example, the species named in s 7(2), the timing windows (notes to s 7 and s 9), and the definition of terminal event in the Schedule. It also affects how other Statements of Principles may be applied where factors cross‑refer to other injuries or diseases (s 11).

Who is not covered: the Statement applies only within the statutory context identified. It does not purport to create obligations outside the VEA/MRCA claims frameworks, and it does not itself impose penalties or criminal liabilities. The instrument repeals an earlier RMA instrument, thereby affecting claim assessments previously governed by the 2010 Statement (s 4).

The Statement itself does not create direct duties or criminal penalties. Instead it prescribes the conditions that decision makers must use when determining whether schistosomiasis or death from schistosomiasis is connected with relevant service under specified claims provisions. The key legal duties and rights that flow from the instrument are therefore administrative and evidentiary.

Duty of application by decision makers: where a claim falls within the scope identified in section 5, the adjudicator must apply this Statement as the RMA's determination of the principles for causation. The Statement sets the threshold test: it is necessary that at least one of the factors listed in section 9 exist, and that the factor be related to the person's relevant service (s 9; s 10(1)). That is the right of the claimant to have causation assessed against a clear set of factors; it is also the administrative duty of decision makers to apply these factors.

Duty to interpret schistosomiasis according to the instrument's definition: decision makers must treat schistosomiasis as defined in subsection 7(2), even though an ICD‑10‑AM code (B65) is noted. The instrument explicitly states that while schistosomiasis attracts ICD‑10‑AM code B65, "in applying this Statement of Principles the meaning of schistosomiasis is that given in subsection (2)" (s 7(3)). The ICD reference is to the specific ICD‑10‑AM edition named (s 7(4)), but the statutory definition controls application.

Right to have material contribution or aggravation assessed under a limited rule for lack of treatment: subsection 10(2) restricts the way the inability to obtain appropriate clinical management factor in section 9(3) operates. That factor applies "only to material contribution to, or aggravation of, schistosomiasis where the person's schistosomiasis was suffered or contracted before or during (but did not arise out of) the person's relevant service" (s 10(2)). The right afforded to claimants in these circumstances is that untreated or undertreated disease may be recognised as materially contributing to or aggravating the condition, but the duty on decision makers is to confine this factor to the specified temporal and causal circumstances.

Duty to connect the factor to relevant service: subsection 10(1) requires that the existence of any factor listed in section 9 "must be related to the relevant service rendered by the person." This imposes an evidentiary duty on claimants to show the nexus between the qualifying factor and the service category defined in the Schedule, and it imposes a duty on decision makers to require and assess evidence of that relationship.

Cross‑application duty: if a factor in section 9 is in respect of an injury or disease covered by another Statement of Principles determined under s 196B(3) of the VEA, the instrument directs that the factors in the other Statement apply "in accordance with the terms of that Statement of Principles as in force from time to time" (s 11). That creates a duty for decision makers to consult and apply other Statements where relevant.

No direct penalty regime in the Statement: the instrument does not set out fines, offences or other sanctions. Its operative effect is procedural and evidentiary within the claims framework. Consequently, rights and duties are framed around proof and assessment rather than compliance with criminal or civil sanction provisions.

The instrument contains no penal provisions and does not itself create enforcement mechanisms in the form of fines, criminal sanctions or administrative penalties. It is a Statement of Principles to be applied within the claims frameworks of the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004 (s 3; s 5). The instrument therefore does not impose enforcement actions; its effect is to guide adjudicators and parties about the medico‑legal criteria for establishing a causal connection between schistosomiasis or death from schistosomiasis and relevant service for claims under the statutory provisions cited.

Enforcement in the sense of application occurs when administrative decision makers and adjudicators decide claims under section 120B of the VEA or section 339 of the MRCA, because the instrument expressly "applies to a claim to which section 120B of the VEA or section 339 of the MRCA applies" (s 5). That is the mechanism by which the Statement produces legally consequential outcomes: acceptance or rejection of claims will depend on whether the required factors are established and whether the factors are related to the person's relevant service (s 9; s 10(1)). The instrument does not itself state which statutory actors must enforce or apply it; those operational roles are set out in the VEA and MRCA machinery referenced in the instrument.

Because there are no sanctions in the instrument, common enforcement concepts such as penalties, infringement notices or administrative fines are not part of this document. Likewise, the instrument does not set compliance monitoring regimes or inspection powers; compliance is assessed in the course of claim adjudication by reference to the facts and medical evidence.

Where the instrument refers to another Statement of Principles, it mandates cross‑application as a matter of legal direction: if a factor in s 9 refers to an injury or disease covered by another Statement determined under subsection 196B(3) of the VEA, then the factors in that other Statement "apply in accordance with the terms of that Statement of Principles as in force from time to time" (s 11). This creates an interlocking enforcement dynamic in the sense that decision makers must apply the relevant SoP(s) together to determine outcomes where etiologies overlap.

Finally, the instrument repeals the earlier 2010 Statement of Principles concerning schistosomiasis (s 4). The repeal is administrative and affects the legal criteria to be applied to claims from the commencement date; it is an instrument‑level change in the regulatory criteria rather than a sanctioning mechanism.

The instrument is expressly made under subsection 196B(3) of the Veterans' Entitlements Act 1986 (s 3). It applies to claims to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies (s 5). Those cross‑references situate the Statement inside the statutory claim frameworks of the VEA and the MRCA. The Statement therefore functions as the RMA's statutory determination of the medical principles to be applied in the adjudication of causation questions under the named provisions.

The Schedule defines "relevant service" in specific statutory categories: 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, and peacetime service under the MRCA (Schedule 1). That definition constrains the range of service for which a connection may be established under this Statement, and a claimant will need to show that the factor set out in s 9 is related to one of these kinds of relevant service in order to satisfy s 10(1).

The instrument cross‑references disease classification systems by noting the ICD‑10‑AM code B65 for schistosomiasis and specifying the edition of the ICD‑10‑AM to be used, including copyright and ISBN information (s 7(3)‑(4)). It also clarifies that, despite the ICD code reference, the legal meaning of schistosomiasis for application of this Statement is the statutory definition in subsection 7(2). That instruction resolves any potential conflict between epidemiological coding and the SoP's definitional scope.

Section 11 provides a mechanism for interaction with other Statements of Principles: if a factor in section 9 applies and refers to an injury or disease that is the subject of another Statement determined under subsection 196B(3) of the VEA, then the other Statement's factors apply according to its terms as in force from time to time. This mechanism creates an order of precedence or cross‑application where etiologies overlap; it requires decision makers to consult and apply other RMA Statements where a factor makes such a reference.

The instrument repeals the previous schistosomiasis Statement (No. 87 of 2010) (s 4). Repeal changes the legal criteria that decision makers must apply to new claims from commencement, meaning that prior decisions relying on the earlier Statement will be assessed according to the current Statement for claims within scope after 22 July 2019; the instrument does not specify transitional arrangements within the text, but the repeal itself is explicit.

Beyond those express interactions the instrument does not purport to amend or override the substantive entitlements, procedural rights, review mechanisms or appeal pathways provided in the VEA or the MRCA; it is an RMA determination whose practical effect is mediated by the claim provisions of those Acts. The instrument does not create or modify offences, and it does not itself establish administrative appeal processes.

The instrument contains a short amendment history within its own text. It expressly repeals the Statement of Principles concerning schistosomiasis No. 87 of 2010 (Federal Register of Legislation No. F2010L02843) that was previously made under subsection 196B(3) of the VEA (s 4). The new instrument is dated 21 June 2019 and commences on 22 July 2019 (s 2). The instrument identifies itself as "Statement of Principles concerning schistosomiasis (Balance of Probabilities) (No. 62 of 2019)" (s 1).

Beyond the explicit repeal of the 2010 Statement, the instrument includes a Schedule that defines MRCA, relevant service, schistosomiasis, terminal event and VEA (Schedule 1). The replacement implies that for all claims falling within its scope from the commencement date decision makers must apply the 2019 Statement rather than the 2010 Statement. The instrument does not include transitional provisions, savings clauses or grandfathering language within its text; it simply states the repeal and the commencement date (s 2; s 4). The absence of transitional language in the document itself means that any transitional practice would need to be located in the administering Acts, in administrative guidance, or in other procedural instruments outside this Statement, none of which are contained in the instrument text.

The instrument also specifies the ICD‑10‑AM edition to which it refers for the purposes of assigning code B65, identifying The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, Tenth Edition, effective date 1 July 2017, with ISBN and copyright attribution (s 7(4)). That reference is a temporal marker for the coding framework used in parallel to the statutory definition, and it may be relevant for future amendments if later editions of ICD‑10‑AM are to be referenced.

No other amendments, modifications or revocations are recorded within the instrument. The limited amendment history is therefore: repeal of the 2010 Statement and replacement by this 2019 Statement effective 22 July 2019.

The instrument as supplied does not record any litigation history. It contains no references to judicial decisions, tribunal determinations or administrative appeals. The text is a statutory Statement of Principles made under subsection 196B(3) of the VEA, and it sets the medico‑legal criteria for causation without citing case law or reporting prior litigation outcomes.

Because the document itself contains no litigation or precedent material, users seeking records of disputes, judicial review or appellate treatment of issues raised by this Statement will need to consult external sources: administrative law and veterans' law databases, tribunal and court records, and decisions interpreting the application of RMA Statements in claims under sections 120B of the VEA and 339 of the MRCA. Those materials are outside the four corners of the instrument and therefore not recorded or summarised in the instrument text.

The instrument does, however, create clear legal tests and defined factual thresholds that are likely to be focal points in any adjudicative contest. For example, litigation or review work would naturally focus on whether a claimant has established (1) cutaneous or mucosal contact with water containing larvae within the 30 years before clinical onset in a way that is related to relevant service (s 9(1); s 10(1)), (2) whether a transplanted organ infected with a specified Schistosoma species occurred within one year before clinical onset where such a factor is claimed (s 9(2)), or (3) whether inability to obtain appropriate clinical management applied in the narrow circumstances set out (s 9(3); s 10(2)). The instrument’s explicit cross‑reference to other Statements of Principles (s 11) also identifies an area where litigation might occur, namely disputes about which SoP governs overlapping etiologies.

In sum, the instrument contains no litigation history or cited cases; it provides the statutory criteria that would be argued about in claims and potential disputes, but any actual litigation outcomes or judicial approaches are not recorded in the Statement itself.

The Statement contains multiple potential procedural and evidential traps for claimants and decision makers if they do not heed its precise wording.

1. Definition controls over ICD code: although the instrument notes that schistosomiasis "attracts ICD‑10‑AM code B65" (s 7(3)), it explicitly instructs that "in applying this Statement of Principles the meaning of schistosomiasis is that given in subsection (2)" (s 7(3)). Practically, a diagnosis coded as B65 in a medical record does not alone define the legal scope; the statutory definition naming specific Schistosoma species and including acute and chronic presentations governs the legal assessment. Decision makers should not rely solely on ICD coding without matching the disease features to subsection 7(2).

2. The 30‑year exposure window requires linkage to clinical onset: section 9(1) requires cutaneous or mucosal contact with water containing Schistosoma larvae "within the 30 years before the clinical onset of schistosomiasis." This very long look‑back period can seem generous, but the claimant must still show the requisite exposure and that the exposure is related to the person's relevant service under s 10(1). Evidence of an exposure years before clinical onset may raise questions about alternate exposures; decision makers must establish the nexus to relevant service rather than simply accept remote contact.

3. Acute versus chronic timing notes are informative but not prescriptive: the notes to s 7 state that acute schistosomiasis usually occurs two to 12 weeks after exposure and chronic schistosomiasis months to several years after exposure. Those clinical timing notes are descriptive; they may assist experts, but they do not alter the statutory 30‑year window in s 9(1). Confusion may arise if decision makers treat the clinical timing notes as the only permissible timelines.

4. The "inability to obtain appropriate clinical management" factor is narrowly constrained: section 9(3) provides this as an alternative factor, but subsection 10(2) restricts its operation to cases of material contribution or aggravation where the disease was suffered or contracted before or during (but did not arise out of) relevant service. That means a claimant cannot use lack of treatment under s 9(3) to establish initial causation where the disease "arose out of" service. The phrase "did not arise out of" is a limiting condition that could be overlooked. Practitioners should be careful to identify the temporal relationship of disease onset to service before relying on s 9(3).

5. Transplant factor has a narrow window: section 9(2) requires that if the factor is a solid organ transplant with the organ infected by a named Schistosoma species, that transplant must have occurred "within the one year before the clinical onset of schistosomiasis." That is a comparatively short interval and will be decisive in borderline cases.

6. Relationship to relevant service is required: subsection 10(1) states plainly that any factor in s 9 "must be related to the relevant service rendered by the person." Evidence of exposure that is unconnected to service (for example, civilian travel or post‑service exposure) will not suffice unless it can be related to one of the statutory categories of relevant service defined in Schedule 1.

7. Cross‑SoP references may shift applicable criteria: section 11 requires that where a s 9 factor refers to an injury or disease covered by another Statement of Principles, the factors in that other Statement apply in accordance with its terms. That can change the evidentiary mix; practitioners must check for overlapping SoPs and ensure the correct SoP is invoked.

8. Death from schistosomiasis is defined via contribution to a terminal event: subsection 7(5) includes "death from a terminal event or condition that was contributed to by the person's schistosomiasis," and the Schedule defines terminal event with examples such as pneumonia and respiratory failure. A death where schistosomiasis is an indirect contributor may therefore fall within scope, but claimants need to show contribution to the terminal event rather than mere presence of past schistosomiasis.

9. Repeal of the 2010 Statement: because the instrument repeals the 2010 Statement (s 4), practitioners must ensure that decisions, medical reports and legal arguments refer to the 2019 Statement from its commencement date onwards and not to the earlier criteria.

10. Absence of penalty or enforcement details: the Statement does not specify procedures for evidence collection, time limits, or appeals. Those procedural matters are governed by the VEA and MRCA and relevant administrative rules. Failure to check those separate procedural requirements could be a practical pitfall.

Each of these points flows directly from the instrument text; practitioners should map evidence requirements carefully to the precise statutory wording to avoid claims being dismissed for failure to match the defined factors and relationship requirements.

This section sets out pragmatic, instrument‑aligned steps for claimants, medical advisers and decision makers preparing or adjudicating claims that rely on this Statement. The guidance below is strictly tied to the provisions and timing windows contained in the instrument.

1. Confirm that the claim falls within scope: verify that the claim is one to which section 120B of the VEA or section 339 of the MRCA applies (s 5). Check that the claimant's service fits the Schedule 1 definition of "relevant service" (eligible war service other than operational service; defence service other than hazardous service and British nuclear test defence service under the VEA; or peacetime service under the MRCA).

2. Establish the diagnosis in terms of the statutory definition: obtain medical documentation that demonstrates infection with one of the Schistosoma species named in subsection 7(2), or medical evidence of the acute or chronic signs and symptoms caused by Schistosome worms or eggs, so medical evidence aligns with the statutory definition rather than relying solely on an ICD code (s 7(2); s 7(3)‑(4)). Ensure clinical records identify the clinical onset date, because the temporal windows in section 9 are measured from clinical onset.

3. For the water contact factor (s 9(1)): assemble contemporaneous or corroborative evidence demonstrating cutaneous or mucosal contact with water containing larvae within the 30 years before clinical onset. The instrument includes examples of contact such as swimming, wading, washing in, and drinking contaminated water (s 9 note 1). Useful documents include service records showing locations and activities, witness statements describing conduct (for example, swimming or wading in freshwater during service), travel logs, unit diaries, and photographs. Also provide contextual evidence about the environmental conditions at the time (for example, lack of sanitation) if available, because the instrument notes that larvae are most likely where facilities for disposal of human waste are minimal and the water is likely contaminated with human faeces and urine (s 9 note 2).

4. For the transplant factor (s 9(2)): obtain surgical and transplant records, pathology reports, and any donor organ infection testing that can identify the presence of a Schistosoma species in the transplanted organ. Crucially, show that the infected organ transplant occurred within one year before the clinical onset of schistosomiasis. Provide timelines and medical reports linking the transplant event, the infection status of the organ, and the onset of clinical disease.

5. For the inability to obtain appropriate clinical management factor (s 9(3) and s 10(2)): collect evidence documenting attempts to obtain appropriate clinical management and the reasons those attempts failed. This can include referrals, appointment records, correspondence, evidence of absence of local health services, or administrative barriers. Importantly, s 10(2) limits this factor to cases where the disease was suffered or contracted before or during, but did not arise out of, relevant service. Therefore, also provide clear evidence about when the schistosomiasis was suffered or contracted relative to the period of relevant service and the reasons the disease did not "arise out of" service.

6. Show the relationship to relevant service (s 10(1)): for whichever s 9 factor is relied upon, prepare material that ties that factor to the claimant’s relevant service. For example, if relying on water contact, provide service records, unit orders, area maps, training materials showing that the water contact occurred while performing duties that fall within the Schedule’s relevant service categories. For cases involving civilian exposures, explain and document why the exposure is nevertheless related to relevant service if that is asserted.

7. Address death from schistosomiasis if applicable (s 7(5); Schedule 1): if the claim concerns death, obtain the medical cause of death, coronial materials if available, and expert opinions that address whether the schistosomiasis contributed to the terminal event. Because the Schedule lists terminal events by example, experts should be asked to articulate causation chains showing that schistosomiasis contributed to the proximate or ultimate cause of death such as pneumonia or respiratory failure.

8. Prepare expert medico‑legal reports tailored to the Statement's elements: ask medical experts to address the statutory definition of schistosomiasis, the presence of a named Schistosoma species where possible, the date of clinical onset, the plausibility of infection following the claimed exposure within the 30‑year window, whether a transplant satisfies the one‑year window and was infected, and whether lack of appropriate clinical management materially contributed to aggravation where applicable. Where overlapping etiologies exist, request that experts also identify whether any factor invokes another Statement of Principles so that s 11 can be considered.

9. Check for cross‑application with other Statements (s 11): if any factor in s 9 refers to an injury or disease covered by another Statement of Principles, locate and apply the relevant other Statement "in accordance with the terms of that Statement of Principles as in force from time to time" (s 11). This may change the factual elements required for acceptance.

10. Maintain clear timelines and document chain of events: because the statutory windows are relative to clinical onset, keep a clear chronology that links service dates, exposure or transplant dates, clinical onset and medical interventions. The difference between "suffered or contracted before or during (but did not arise out of) relevant service" and disease arising out of service will be a factual issue; clear chronology assists decision makers.

11. Be mindful of the repeal of the 2010 Statement (s 4): for claims straddling the repeal date, check the administrative rules or seek guidance on transitional practice outside the instrument text. The 2019 Statement is the operative document from its commencement date.

Following these steps aligns evidence and expert opinion with the specific statutory tests and limitations contained in the instrument, and reduces the risk that a claim will be decided without addressing the precise factors and relationships the RMA has prescribed.