Statement of Principles concerning traumatic contusion or haematoma (Reasonable Hypothesis) (No. 43 of 2024)

This instrument is a Repatriation Medical Authority Statement of Principles (SoP) titled Statement of Principles concerning traumatic contusion or haematoma (Reasonable Hypothesis) (No. 43 of 2024). Mechanically, it:

• Is made under subsection 196B(2) of the Veterans’ Entitlements Act 1986, cited in the instrument as the source of authority (s 3).
• Commences on 23 July 2024 (s 2).
• Repeals the earlier Statement of Principles concerning external bruise No. 5 of 2016 (Federal Register F2016L00008) made under the same statutory power (s 4).
• Applies to claims to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 (MRCA) applies (s 5).

Substantively, the instrument defines the illness/injury covered, the minimum factual factors necessary to raise a reasonable hypothesis that the condition is connected to relevant service, and the relationship those factors must have to the veteran’s service (ss 7-11). It:

• Defines “traumatic contusion or haematoma” as a blood collection in skin, tissue or organ caused by application of physical force resulting in tissue damage and internal bleeding, and expressly includes contusions of listed organs and structures while excluding blood collections associated with fracture and certain intracranial haemorrhages (s 7(2)).
• Extends the SoP to death from traumatic contusion or haematoma where the contusion or haematoma contributed to the person’s terminal event or condition (s 7(3) and Schedule 1 definition of “terminal event”).
• States the Repatriation Medical Authority’s view that there is sound medical‑scientific evidence that such contusions/haematomas can be related to relevant service rendered under the VEA or MRCA (s 8).
• Prescribes two alternative factual factors, of which at least one must exist to raise a reasonable hypothesis connecting the condition to service: (1) trauma to the affected site within 24 hours before clinical onset, or (2) inability to obtain appropriate clinical management for the contusion/haematoma before clinical worsening (s 9).
• Requires that any such factor be related to the person’s relevant service, as defined in Schedule 1, and places a limiting qualification on the second factor when the contusion was suffered before or during, but did not arise out of, the relevant service (s 10).

In short, the instrument replaces the 2016 external bruise SoP, provides a fresh definitional frame for traumatic contusion or haematoma and death from it, and stipulates two minimum evidentiary factors and their relationship to relevant service for claims under the VEA and MRCA framework.

The instrument organises around a small set of technical concepts that determine coverage and evidentiary thresholds. Each concept is defined or grounded in a numbered provision or the Schedule 1 dictionary.

• Traumatic contusion or haematoma (definition): The SoP defines the condition as “a blood collection in the skin, tissue or organ as a result of application of physical force causing tissue damage and internal bleeding” (s 7(2)(a)). It expressly includes contusions of organs (heart, pericardium, lung, pleura, liver, spleen, kidneys), bone, joint, eye and orbit (s 7(2)(b)). The Schedule cross-references this definition (Schedule 1 item “traumatic contusion or haematoma,see subsection 7(2)”).
• Exclusions: The instrument excludes two categories from the definition: blood collections associated with a fracture; and blood collections associated with subarachnoid, subdural, extradural haemorrhage or cerebrovascular accident (s 7(2)(c)(i)-(ii)). There is an explicit procedural note that if the haematoma affects only the brain, the moderate to severe traumatic brain injury SoP is to be preferred (s 7(2) Note 1).
• Death: Death from traumatic contusion or haematoma is included where the contusion/haematoma contributed to the person’s terminal event or condition. The Schedule defines “terminal event” to include pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (s 7(3); Schedule 1).
• Relevant service: The SoP is applicable only in the context of defined categories of “relevant service” which the Schedule lists as operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, or warlike and non-warlike service under the MRCA (Schedule 1).
• Reasonable hypothesis and minimum factors: The SoP sets an evidentiary threshold for a “reasonable hypothesis” by specifying minimum factors. At least one of the two enumerated factors must exist to raise a reasonable hypothesis connecting the condition or death to relevant service: trauma to the affected site within 24 hours before clinical onset (s 9(1)); or inability to obtain appropriate clinical management before clinical worsening (s 9(2)).
• Temporal and causal qualifications: Section 10 requires that any factor in s 9 be related to the person’s relevant service. Subsection 10(2) limits the second factor (inability to obtain appropriate clinical management) to instances where the contusion/haematoma was suffered or contracted before or during, but did not arise out of, the person’s relevant service, and then the factor is limited to material contribution to, or aggravation of, the condition.

The instrument operates in the administrative claims environment established by the Veterans’ Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004, and it therefore affects the following parties in the claims process.

• Claimants: Veterans, members of Peacekeeping Forces, and members of the Forces falling under the VEA or MRCA whose claims for compensation, pension or treatment relate to traumatic contusion or haematoma or death from such a condition. The SoP explicitly “applies to a claim to which section 120A of the VEA or section 338 of the MRCA applies” (s 5). That means persons making claims under those statutory provisions must be assessed against this SoP when the condition in question is a traumatic contusion or haematoma as defined (s 7).
• Decision‑makers: Administrative decision-makers who assess eligibility under the VEA or MRCA will use the SoP as the stipulated medical-scientific framework for determining whether a reasonable hypothesis exists connecting the condition to relevant service (s 3, s 8). The RMA’s statement that there is “sound medical‑scientific evidence” underpins this SoP’s use by decision-makers (s 8).
• Medical advisers and treating clinicians: The SoP sets medical criteria that clinicians’ records will be read against,specifically timing of trauma (within 24 hours of clinical onset), evidence of inability to obtain appropriate clinical management, and whether a contusion/haematoma falls within the definitional inclusions or exclusions (s 7, s 9).
• Legal and medical representatives: Lawyers, advocates and medical experts preparing claims or reviews must align evidence to the two alternative minimal factors (s 9), demonstrate relation to the relevant service categories in Schedule 1 and be mindful of the SoP’s exclusions (s 7(2)(c)).
• The Repatriation Medical Authority (RMA): The instrument is made by the RMA under its statutory power (s 3). The RMA is the body that determined the SoP and thereby sets the medical criteria to be used administratively (s 8).
• Administrators of benefits and tribunals: Entities charged with applying the VEA and MRCA claims processes must apply this SoP where applicable; the SoP’s procedural cross-references (s 11) mean administrators must also check whether other SoPs apply where a s 9 factor refers to another injury or disease.

The Schedule’s definition of “relevant service” (Schedule 1) places the SoP’s operation squarely within the categories of service recognised by the VEA and MRCA. Practically, parties who are not claimants but who provide records (hospitals, private clinicians, military health services) will be affected because the SoP makes the existence and timing of clinical records central to whether the statutory threshold of a reasonable hypothesis is met (s 9).

This SoP does not itself prescribe duties or criminal penalties. It is a medical criteria instrument that sets the minimum facts required to raise a reasonable hypothesis connecting traumatic contusion or haematoma to relevant service. Nevertheless, it creates clear duties and evidentiary expectations within the claims framework. From the instrument, the practical duties and rights are as follows.

Duties and evidentiary expectations on claimants and their representatives:

• Establish at least one of the two minimum factors in s 9 to raise a reasonable hypothesis: either trauma involving the affected site within 24 hours before clinical onset (s 9(1)(1)), or inability to obtain appropriate clinical management before clinical worsening (s 9(1)(2)). The duty is to adduce facts to satisfy one of these alternatives.
• Demonstrate that the asserted factor is related to the person’s relevant service (s 10(1)). “Relevant service” is defined in Schedule 1 and includes operational, peacekeeping, hazardous and British nuclear test defence service under the VEA, and warlike and non-warlike service under the MRCA (Schedule 1).
• Where the second factor (inability to obtain appropriate clinical management) is relied on, and the contusion was suffered or contracted before or during, but did not arise out of, relevant service, the claimant must show that the inability to obtain appropriate clinical management materially contributed to or aggravated the contusion/haematoma (s 10(2)).

Rights and decision-making obligations on administrators and medical assessors:

• Apply the SoP in assessing whether a reasonable hypothesis exists (s 3, s 8). The instrument is explicit that the RMA is of the view that sound medical‑scientific evidence supports a link between traumatic contusion/haematoma and relevant service (s 8); this is the evidentiary basis for the SoP’s adoption.
• Where a factor in s 9 refers to an injury/disease covered by another SoP, apply that other SoP’s factors as they are in force (s 11). This gives decision-makers an obligation to cross-check other relevant SoPs and apply their tests where appropriate.
• Take account of the exclusions in s 7(2)(c) in excluding certain presentations from the scope of this SoP (blood collections associated with fracture; blood collections associated with subarachnoid, subdural, extradural haemorrhage or cerebrovascular accident).

Procedural and substantive consequences:

• The SoP’s definition of death from traumatic contusion or haematoma means that where a contusion/haematoma contributed to a terminal event (as defined in Schedule 1), a claim for death related to service may be assessed under this SoP (s 7(3); Schedule 1). Thus administrators must consider terminal events such as pneumonia and respiratory failure in assessing contribution.

The instrument contains no penalties, sanctions, criminal offences, or express enforcement mechanisms within its text. It is a Statement of Principles issued by the Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 and functions as a medical criteria instrument used in administrative decision-making. The relevant enforcement and consequence architecture flows from the VEA and MRCA claims framework rather than from the SoP itself.

What the SoP does establish that affects enforcement and administrative outcome:

• The SoP sets the minimum factual factors necessary to raise a reasonable hypothesis that the condition is related to relevant service (s 9). Administrative decision-makers will apply those factors in deciding whether a claim meets statutory requirements under the VEA or MRCA sections referenced in s 5. While the SoP does not itself enjoin a particular benefit outcome, it alters the evidentiary baseline that determines entitlement in those processes.
• Where an administrative decision-maker finds that a claimant has not established the necessary factor(s) or relation to relevant service as required by sections 9 and 10, the immediate practical enforcement consequence is that the claim may be rejected or not accepted as service-related under the VEA/MRCA process. That outcome is an administrative denial rather than a statutory penalty imposed by the SoP.
• Section 11 requires decision-makers to follow other SoPs where s 9 refers to an injury or disease covered by another SoP. Non‑application of that provision could lead to error in law in administrative review or merits review processes under the VEA or MRCA framework. Again, the SoP itself does not specify remedies or sanctions for misapplication; remedies would be those available under the enabling Acts and administrative law.

Administrative oversight and review:

• The SoP is a determinative piece of medical-scientific guidance used in assessing claims. Parties dissatisfied with claim outcomes retain whatever rights of internal review, merits review or judicial review are available under the VEA or MRCA administrative framework. The SoP does not describe or modify those rights; it supplies the medical criteria against which tribunals or appellate bodies will assess the medical links in contested cases.

Implied compliance risk for medical professionals and records custodians:

• Although the SoP creates no professional disciplinary penalties, the absence of appropriate medical records conforming to the SoP’s temporal and management-related factors (s 9) increases the risk of unsuccessful claims. The SoP therefore has an indirect enforcement effect by making certain types and timing of clinical documentation relevant to administrative outcomes.

The Statement of Principles is explicitly created under the statutory power in the Veterans’ Entitlements Act 1986 and applies to claims governed by provisions of the VEA and the MRCA. The instrument both references and depends on those Acts and other SoPs in several ways.

Statutory basis and application:

• The instrument is made under subsection 196B(2) of the VEA (s 3). That subsection authorises the Repatriation Medical Authority to determine Statements of Principles; the SoP is therefore an instrument produced under that statutory power and intended to be used in decisions under the VEA and related statutes.
• It applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (s 5). The SoP does not reproduce those sections; it attaches itself to the eligibility and claims processes governed by those provisions. The practical consequence is that the definition and factors in the SoP will be utilised in assessing claims made under the enumerated statutory triggers.

Interaction with other Statements of Principles:

• Section 11 sets a cross-SoP rule: if a factor in section 9 applies and that factor refers to an injury or disease covered by another SoP determined under subsection 196B(2) of the VEA, then the factors in that other SoP “apply in accordance with the terms of that Statement of Principles as in force from time to time” (s 11). This creates an interoperability mechanism whereby connected injuries/diseases are governed by the other SoP’s tests instead of or in addition to this one.
• The note in s 7(2) stating that if traumatic haematoma is only affecting the brain then “the moderate to severe traumatic brain injury SoP would be preferred” is a specific instruction on which SoP to use in that clinical presentation (s 7(2) Note 1). Decision-makers must therefore identify the correct SoP when overlap is possible.

Exclusions and related conditions:

• The SoP excludes blood collections associated with fractures and with subarachnoid, subdural, extradural haemorrhage or cerebrovascular accident (s 7(2)(c)(i)-(ii)). Those excluded clinical entities will be assessed, if they are the claimed condition, under whatever other SoPs are applicable or under the general claims processes of the VEA/MRCA. The instrument therefore delineates scope vis-à-vis other clinical categories.
• The inclusion of death from traumatic contusion/haematoma where the contusion contributed to a terminal event (s 7(3)) requires administrators to engage with how terminal events are evaluated in statutes and existing SoPs. The Schedule’s list of terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) will interact with cause-of-death frameworks in other instruments or in the enabling statutes.

The instrument contains its own limited amendment and replacement history within its text.

• It is identified as Statement of Principles concerning traumatic contusion or haematoma (Reasonable Hypothesis) (No. 43 of 2024) and is dated 21 June 2024 (preamble and signature block). The instrument’s commencement is 23 July 2024 (s 2).
• The instrument expressly repeals the earlier Statement of Principles concerning external bruise No. 5 of 2016 (Federal Register of Legislation No. F2016L00008) made under the same statutory power (s 4). The repeal is absolute in text; the instrument does not specify transitional savings, amendments to other instruments or staged substitution rules beyond the single repeal.
• There are no other amendments listed in the instrument. No prior versions of this specific SoP are embedded in the text. The instrument does not provide a legislative history beyond those two datapoints: the replacement of the 2016 SoP and the new instrument’s date and commencement.

What the instrument does not do in its amendment history:

• It does not specify whether any claims already decided under the repealed 2016 SoP are to be reopened or subjected to review under the new SoP. The instrument is silent on transitional application to claims pending at commencement.
• It does not include an express savings clause preserving decisions made under the repealed SoP. Decision-makers will therefore need to rely on the operative rules in the VEA, MRCA, or in general administrative law to determine whether earlier decisions stand or are affected by the repeal.

Documentary provenance:

• The instrument is signed by the Chairperson of the Repatriation Medical Authority on behalf of the Authority (signature block), thereby recording the administrative authorisation for the SoP’s determination (preamble). The authorising statutory provision is s 196B(2) of the VEA (s 3).

In practice, the amendment history relevant to practitioners and claimants is straightforward: the 2016 external bruise SoP has been repealed; from 23 July 2024 the 2024 traumatic contusion or haematoma SoP governs the medical criteria for claims that fall within its scope (ss 2, 4, 5). Any further amendments would only be apparent from subsequent instruments or notices issued by the Repatriation Medical Authority; none are included in the supplied text.

The text of this Statement of Principles contains no litigation history, no references to cases, judicial decisions, or tribunal determinations that interpret or apply this instrument. The instrument does not cite any judicial authorities. It records only the RMA’s view that sound medical‑scientific evidence supports the relationship between the condition and relevant service (s 8).

What this means for practitioners and claimants:

• There is no author-provided or instrument-contained case law to guide interpretation of the new definitions or the application of the minimum factors in ss 9-10. Any legal interpretation questions will therefore be resolved by administrative decision-makers, tribunals or courts in future cases; the instrument itself does not provide precedent.
• Section 11 contemplates the application of other SoPs where a s 9 factor refers to an injury or disease already covered by another SoP. Interpretation of how s 11 operates in practice may therefore depend in future on tribunal or judicial decisions concerning interaction between multiple SoPs. However, the instrument does not identify any such decisions.
• The Notes in s 7 (for example Note 1 directing preference for a moderate to severe traumatic brain injury SoP where the haematoma is only affecting the brain, and Note 3 describing acute compartment syndrome as an integral manifestation of the contusion) are administrative guidance within the instrument. They are not judicially vetted conclusions within the text.

Implications for review and challenge:

• Absent any litigation history in the instrument, claimants and advisers must prepare for a period in which the new SoP is applied administratively without adjudicative interpretation. Challenges to the application of the SoP,if they arise,would proceed through the review mechanisms in the VEA/MRCA and ultimately through judicial review avenues, where questions of statutory construction, the RMA’s exercise of its medical-scientific discretion under s 196B(2), or misapplication of the SoP could be litigated. The instrument itself does not articulate any standing or procedural prerequisites for such challenges; those are governed by the enabling statutes and general administrative law.

In summary, there is no litigation history contained in this instrument. All interpretive or legal disputes about application will depend on future administrative practice and any tribunal or court decisions that address this SoP and its interaction with the VEA/MRCA framework.

The instrument is concise, but several provisions present potential pitfalls for claimants, medical advisers and decision-makers. These are concrete, source‑grounded points to watch when preparing or assessing claims.

1. The 24‑hour timing requirement in s 9(1)(1)

• One of the two alternative minimum factors is an explicit temporal test: “having trauma involving the affected site within the 24 hours before clinical onset” (s 9(1)(1)). If a claimant cannot establish trauma within that 24‑hour window, reliance on that primary factor will fail. Practitioners must therefore align documentation precisely to that timeframe when this factor is asserted.

2. The alternative factor’s limited applicability (s 9(1)(2) and s 10(2))

• The second minimum factor is inability to obtain appropriate clinical management for the contusion/haematoma before clinical worsening (s 9(1)(2)). Section 10(2) narrows this factor: it “applies only to material contribution to, or aggravation of, traumatic contusion or haematoma where the person’s traumatic contusion or haematoma was suffered or contracted before or during (but did not arise out of) the person’s relevant service.” Two immediate implications follow:
  • That factor cannot be used as a general fallback for any delay in care; it is confined to situations where the contusion pre-existed or was contracted before/during service but did not arise out of the service.
  • The claimant must show both an inability to obtain appropriate management and that this inability materially contributed to or aggravated the condition. The instrument places the material contribution/aggravation limitation into the legal test (s 10(2)).

3. Scope exclusions (s 7(2)(c))

• Blood collections associated with fractures, and intracranial haemorrhages of the subarachnoid, subdural, extradural types and cerebrovascular accidents, are excluded from this SoP (s 7(2)(c)). Such presentations must be assessed under other SoPs or medical frameworks. Failure to identify and apply the correct SoP can lead to misclassification.

4. Brain-only haematoma guidance (s 7(2) Note 1)

• The Note that if traumatic haematoma is only affecting the brain, then the moderate to severe traumatic brain injury SoP would be preferred presents an administrative “choice of instrument” issue. Decision‑makers and advisers must identify the primary affected structure and choose the appropriate SoP.

Compliance for claimants and their advisers requires aligning documentary and clinical evidence to the SoP’s narrow factual predicates and service nexus rules. The following steps, drawn from the instrument’s text, set out practical compliance tasks.

1. Identify whether the condition falls within the SoP’s definition

• Confirm the condition is a “traumatic contusion or haematoma” as defined in s 7(2)(a)-(b): a blood collection in the skin, tissue or organ caused by application of physical force producing tissue damage and internal bleeding. Exclude cases where the blood collection is associated with a fracture or with the specific intracranial haemorrhages or cerebrovascular accident listed in s 7(2)(c).
• If the haematoma affects only the brain, apply or consider the moderate to severe traumatic brain injury SoP instead, per the Note to s 7(2).

2. Establish one of the minimum factors in s 9

• If relying on the trauma timing factor (s 9(1)(1)):
  • Collect contemporaneous incident reports, medical notes or service records that record trauma to the affected site and show the timing of trauma relative to clinical onset. The SoP requires trauma “within the 24 hours before clinical onset,” so documentation must support that temporal proximity.
  • Clinical notes should specify site of trauma and clinical onset time/symptom emergence to enable the 24‑hour calculation.
• If relying on the inability to obtain appropriate clinical management factor (s 9(1)(2)):
  • Document attempts to obtain timely and appropriate clinical care (dates, times, facility names, referral attempts, communications with medical authorities), and show clinical worsening occurred after the inability to obtain care.
  • Where the contusion was suffered or contracted before or during, but did not arise out of, relevant service, show that the inability to obtain appropriate clinical management materially contributed to or aggravated the contusion (s 10(2)). That requires evidence linking failure of access to care with subsequent clinical deterioration.

3. Demonstrate the nexus to relevant service (s 10(1); Schedule 1)

• Map the event(s) and any inability to obtain care to the claimant’s service record and the Schedule’s definition of “relevant service.” The claimant must show that the s 9 factor is related to one of the listed service categories (operational, peacekeeping, hazardous, British nuclear test defence under the VEA; warlike/non-warlike under the MRCA).