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Statement of Principles

Incisional hernia — DVA SoP factors

Every factor in the Repatriation Medical Authority Statements of Principles for Incisional hernia. DVA can only accept a claim for Incisional 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.

Incisional hernia

RH No. 73 of 2016 · BoP No. 74 of 201622 factors

Meaning of incisional hernia: For the purposes of this Statement of Principles, incisional hernia means: (a) a protrusion of intra-abdominal tissue through a fascial defect in the abdominal wall at the site of a previous surgical incision; and (b) includes incisional hernia that recurs following surgical repair of an incisional hernia. (3) While incisional hernia attracts ICD-10-AM code K43.0, K43.1 or K43.2, in applying this Statement of Principles the meaning of incisional hernia is that given in subsection (2). (4) For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-020-5.

Reasonable Hypothesis (RH) — Statement of Principles No. 73 of 2016

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 incisional hernia or death from incisional hernia with the circumstances of a person's relevant service:

  1. (1)
    having an incision for a surgical procedure before the clinical onset of incisional hernia, where the hernia is at the site of that incision;
  2. (2)
    having a pre-existing scar at the site of the incision for a surgical procedure before the clinical onset of incisional hernia, where the hernia is at the site of that incision;
  3. (3)
    having a superficial infection of the affected incision within 30 days of the surgical procedure, in the five years before the clinical onset of incisional hernia;

    Note: superficial infection of the affected incision is defined in the Schedule 1 - Dictionary.

  4. (4)
    having a deep infection of the affected incision within 90 days of the surgical procedure, in the five years before the clinical onset of incisional hernia;

    Note: deep infection of the affected incision is defined in the Schedule 1 - Dictionary.

  5. (5)
    having wound dehiscence as specified of the affected incision before the clinical onset of incisional hernia;

    Note: wound dehiscence as specified is defined in the Schedule 1 - Dictionary.

  6. (6)
    being obese before the clinical onset of incisional hernia, and at the time of the surgical incision at the affected site;

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

  7. (7)
    being treated with sirolimus or everolimus as specified before the clinical onset of incisional hernia, where the treatment occurred within the three years following the surgical incision;

    Note: being treated with sirolimus or everolimus as specified is defined in the Schedule 1 - Dictionary.

  8. (8)
    being treated with systemic bevacizumab before the clinical onset of incisional hernia, where the treatment occurred within the one year following the surgical incision;
  9. (9)
    having ascites, abdominal distension, or chronic ambulatory peritoneal dialysis before the clinical onset of incisional hernia, where these conditions occurred within the one year following the surgical incision;
  10. (10)
    having Marfan syndrome before the clinical onset of incisional hernia;
  11. (11)
    having increased intra-abdominal pressure as specified at the time of the clinical worsening of incisional hernia;

    Note: increased intra-abdominal pressure as specified is defined in the Schedule 1 - Dictionary.

  12. (12)
    inability to obtain appropriate clinical management for incisional hernia;

Aggravation-only factors: the factors in subsections 8(11) and 8(12) 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. 74 of 2016

10 factors

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

  1. (1)
    having an incision for a surgical procedure before the clinical onset of incisional hernia, where the hernia is at the site of that incision;
  2. (2)
    having a pre-existing scar at the site of the incision for a surgical procedure before the clinical onset of incisional hernia, where the hernia is at the site of that incision;
  3. (3)
    having a superficial infection of the affected incision within 30 days of the surgical procedure, in the five years before the clinical onset of incisional hernia;

    Note: superficial infection of the affected incision is defined in the Schedule 1 - Dictionary.

  4. (4)
    having a deep infection of the affected incision within 90 days of the surgical procedure, in the five years before the clinical onset of incisional hernia;

    Note: deep infection of the affected incision is defined in the Schedule 1 - Dictionary.

  5. (5)
    having wound dehiscence as specified of the affected incision before the clinical onset of incisional hernia;

    Note: wound dehiscence as specified is defined in the Schedule 1 - Dictionary.

  6. (6)
    being obese before the clinical onset of incisional hernia, and at the time of the surgical incision at the affected site;

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

  7. (7)
    being treated with sirolimus or everolimus as specified before the clinical onset of incisional hernia, where the treatment occurred within the three years following the surgical incision;

    Note: being treated with sirolimus or everolimus as specified is defined in the Schedule 1 - Dictionary.

  8. (8)
    having Marfan syndrome before the clinical onset of incisional hernia;
  9. (9)
    having increased intra-abdominal pressure as specified at the time of the clinical worsening of incisional hernia;

    Note: increased intra-abdominal pressure as specified is defined in the Schedule 1 - Dictionary.

  10. (10)
    inability to obtain appropriate clinical management for incisional hernia;

Aggravation-only factors: the factors in subsections 8(9) and 8(10) 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.

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