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Statement of Principles

Hiatus hernia — DVA SoP factors

Every factor in the Repatriation Medical Authority Statements of Principles for Hiatus hernia. DVA can only accept a claim for Hiatus hernia if at least one of these factors is met and connected to your service. Reasonable Hypothesis (RH) applies to operational service; Balance of Probabilities (BoP) applies to peacetime service.

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Source: Repatriation Medical Authority Statements of Principles as held by the Veterans Health Centre. SoPs are amended and replaced regularly; always confirm the current instrument at rma.gov.au before relying on it.

Hiatus hernia

RH No. 60 of 2022 · BoP No. 61 of 202226 factors

Meaning of hiatus hernia: For the purposes of this Statement of Principles, hiatus hernia: (a) means an acquired protrusion of intra-abdominal tissue through the oesophageal hiatus of the diaphragm into the thoracic cavity; and (b) includes: (i) mixed sliding and paraoesophageal hiatus hernia; (ii) paraoesophageal hiatus hernia; and (iii) sliding hiatus hernia; and (c) excludes: (i) congenital hiatus hernia; (ii) eventration of the diaphragm; and (iii) physiological herniation during swallowing.

Reasonable Hypothesis (RH) — Statement of Principles No. 60 of 2022

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting hiatus hernia or death from hiatus hernia with the circumstances of a person's relevant service:

  1. (1)
    having a surgical procedure that involves the region of the oesophageal hiatus or affects the structures supporting the oesophageal hiatus, within the 2 years before the clinical onset of hiatus hernia;

    Note: Examples of surgical procedures that can involve the region of the oesophageal hiatus or affect the structures supporting the oesophageal hiatus include bariatric surgery, coronary artery bypass grafting, gastrectomy, oesophagectomy and pulmonary lobe resection.

  2. (2)
    having a blunt or penetrating injury, excluding a surgical procedure, to the region of the oesophageal hiatus, within the 5 years before the clinical onset of hiatus hernia;
  3. (3)
    having acute elevation of pressure within the abdominal cavity due to any one of the following: (a) acute abdomen; (b) anti-G straining manoeuvre; (c) lifting heavy weights; (d) significant gagging or vomiting; or (e) underwater diving with compressed air; within the 7 days before the clinical onset of hiatus hernia;

    Note: acute abdomen is defined in the Schedule 1 - Dictionary.

  4. (4)
    being overweight or obese for at least the 2 years before the clinical onset of hiatus hernia;

    Note: being overweight or obese is defined in the Schedule 1 - Dictionary.

  5. (5)
    being pregnant at the time of the clinical onset of hiatus hernia;
  6. (6)
    having chronic elevation of pressure within the abdominal cavity due to ascites or chronic peritoneal dialysis at the time of the clinical onset of hiatus hernia;
  7. (7)
    having systemic sclerosis at the time of the clinical onset of hiatus hernia;
  8. (8)
    having kyphosis or kyphoscoliosis of the thoracic spine at the time of the clinical onset of hiatus hernia;
  9. (9)
    having a surgical procedure that involves the region of the oesophageal hiatus or affects the structures supporting the oesophageal hiatus, within the 2 years before the clinical worsening of hiatus hernia;

    Note: Examples of surgical procedures that can involve the region of the oesophageal hiatus or affect the structures supporting the oesophageal hiatus include bariatric surgery, coronary artery bypass grafting, gastrectomy, oesophagectomy and pulmonary lobe resection.

  10. (10)
    having a blunt or penetrating injury, excluding a surgical procedure, to the region of the oesophageal hiatus, within the 5 years before the clinical worsening of hiatus hernia;
  11. (11)
    having acute elevation of pressure within the abdominal cavity due to any one of the following: (a) acute abdomen; (b) anti-G straining manoeuvre; (c) lifting heavy weights; (d) significant gagging or vomiting; or (e) underwater diving with compressed air; within the 7 days before the clinical worsening of hiatus hernia;

    Note: acute abdomen is defined in the Schedule 1 - Dictionary.

  12. (12)
    being overweight or obese for at least the 2 years before the clinical worsening of hiatus hernia;

    Note: being overweight or obese is defined in the Schedule 1 - Dictionary.

  13. (13)
    being pregnant at the time of the clinical worsening of hiatus hernia;
  14. (14)
    having chronic elevation of pressure within the abdominal cavity due to ascites or chronic peritoneal dialysis at the time of the clinical worsening of hiatus hernia;
  15. (15)
    having systemic sclerosis at the time of the clinical worsening of hiatus hernia;
  16. (16)
    having kyphosis or kyphoscoliosis of the thoracic spine at the time of the clinical worsening of hiatus hernia;
  17. (17)
    inability to obtain appropriate clinical management for hiatus hernia;

Aggravation-only factors: the factors in subsections 9(9) to 9(17) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

Balance of Probabilities (BoP) — Statement of Principles No. 61 of 2022

9 factors

At least one of the following factors must exist before it can be said that, on the balance of probabilities, hiatus hernia or death from hiatus hernia is connected with the circumstances of a person's relevant service:

  1. (1)
    having a surgical procedure that involves the region of the oesophageal hiatus or affects the structures supporting the oesophageal hiatus, within the 2 years before the clinical onset of hiatus hernia;

    Note: Examples of surgical procedures that can involve the region of the oesophageal hiatus or affect the structures supporting the oesophageal hiatus include bariatric surgery, coronary artery bypass grafting, gastrectomy, oesophagectomy and pulmonary lobe resection.

  2. (2)
    having a blunt or penetrating injury, excluding a surgical procedure, to the region of the oesophageal hiatus, within the 2 years before the clinical onset of hiatus hernia;
  3. (3)
    being obese for at least the 2 years before the clinical onset of hiatus hernia;

    Note: being obese is defined in the Schedule 1 - Dictionary.

  4. (4)
    being pregnant at the time of the clinical onset of hiatus hernia;
  5. (5)
    having a surgical procedure that involves the region of the oesophageal hiatus or affects the structures supporting the oesophageal hiatus, within the 2 years before the clinical worsening of hiatus hernia;

    Note: Examples of surgical procedures that can involve the region of the oesophageal hiatus or affect the structures supporting the oesophageal hiatus include bariatric surgery, coronary artery bypass grafting, gastrectomy, oesophagectomy and pulmonary lobe resection.

  6. (6)
    having a blunt or penetrating injury, excluding a surgical procedure, to the region of the oesophageal hiatus, within the 2 years before the clinical worsening of hiatus hernia;
  7. (7)
    being obese for at least the 2 years before the clinical worsening of hiatus hernia;

    Note: being obese is defined in the Schedule 1 - Dictionary.

  8. (8)
    being pregnant at the time of the clinical worsening of hiatus hernia;
  9. (9)
    inability to obtain appropriate clinical management for hiatus hernia;

Aggravation-only factors: the factors in subsections 9(5) to 9(9) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

A VHC Diagnostic Assessment addresses each of these factors one by one against your service record and clinical history. See how a VHC DVA claim works, see all fees ($600 + GST per stage) or book an appointment.

About Dr Thomas Perkins

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Founding doctor of the Veterans Health Centre in Ipswich, Queensland, and one of Australia's most experienced practitioners in veterans' medicolegal medicine.

Dr Perkins has spent more than thirteen years working exclusively with current and former ADF members — treating their conditions, writing their reports and navigating the DVA system alongside them. With over 100,000 claims submitted and 2,000 Permanent Impairment Assessments completed, he has seen precisely what separates an accepted claim from a rejected one at every level, from initial liability to the Veterans' Review Board.

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