Statement of Principles

concerning

HEPATITIS B INFECTION
(Reasonable Hypothesis)

(No. 9 of 2026)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated    19 December 2025

Professor Terence Campbell AM

Chairperson

by and on behalf of

The Repatriation Medical Authority

Contents

1 Name

2 Commencement

3 Authority

4 Repeal

5 Application

6 Definitions

7 Kind of injury, disease or death to which this Statement of Principles relates

8 Basis for determining the factors

9 Factors that must exist

10 Relationship to service

11 Factors referring to an injury or disease covered by another Statement of Principles

Schedule 1 - Dictionary

1 Definitions

1.                Name

This is the Statement of Principles concerning hepatitis B infection (Reasonable Hypothesis) (No. 9 of 2026).

1.                Commencement

              This instrument commences on 19 January 2026.

1.                Authority

This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.

1.                Repeal

The Statement of Principles concerning hepatitis B (Reasonable Hypothesis) (No. 13 of 2017) (Federal Register of Legislation No. F2017L00001) made under subsection 196B(2) of the VEA is repealed.

1.                Application

This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.

1.                Definitions

The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.

1.                Kind of injury, disease or death to which this Statement of Principles relates
   1.           This Statement of Principles is about hepatitis B infection and death from hepatitis B infection.

Meaning of hepatitis B infection

1.           For the purposes of this Statement of Principles, hepatitis B infection:
   1.           means infection with the hepatitis B virus resulting in an illness characterised by inflammation of the liver, and which is confirmed by laboratory testing for hepatitis B serological or nucleic acid markers; and
   2.           includes acute and chronic hepatitis B infection.

Note 1: Signs and symptoms of acute hepatitis B infection include fever, tiredness, loss of appetite, nausea, vomiting, abdominal discomfort and jaundice. Chronic hepatitis B is an infection lasting for at least 6 months which may involve both inflammation of the liver and development of fibrosis in the longer term.

Note 2: Clinical worsening may be indicated by the development of chronic hepatitis B from acute hepatitis B, reactivation of past hepatitis B or a hepatitis B flare-up.

Note 3: It will usually be the case that the date of the confirmation of laboratory evidence of hepatitis B serological or nucleic acid markers is after the date of clinical onset.

Note 4: Clinical onset is defined in the schedule 1 – Dictionary.

1.           While hepatitis B infection attracts ICD‑10‑AM code B16, B18.0 or B18.1, in applying this Statement of Principles the meaning of hepatitis B infection is that given in subsection (2).
2.           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), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.

Death from hepatitis B infection

1.           For the purposes of this Statement of Principles, hepatitis B infection, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's hepatitis B infection.

Note: terminal event is defined in the Schedule 1 – Dictionary.

1.                Basis for determining the factors

The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that hepatitis B infection and death from hepatitis B infection can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the MRCA.

Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.

1.                Factors that must exist

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 hepatitis B infection or death from hepatitis B infection with the circumstances of a person's relevant service:

1.           having percutaneous (intravenous, intramuscular, subcutaneous or intradermal) or permucosal exposure to a body substance which is derived from a person infected with the hepatitis B virus at least 30 days before clinical onset;

Note: The body substance may include blood, blood products or any body fluid containing blood, saliva, semen or vaginal secretions, serum-derived fluids (serous discharge, amniotic, cerebrospinal, pericardial, peritoneal, pleural or synovial fluids), tissues or organs.

1.           living or working for a continuous period of at least 90 days in an area which, at that time, has a population prevalence of hepatitis B chronic infection of at least 2% before clinical onset;
2.           being a prisoner of War of Japan before clinical onset;
3.           having served in South-East Asia, the Mediterranean region or the Pacific region during World War 2 before clinical onset;
4.           inability to access appropriate hepatitis B vaccination before exposure to hepatitis B virus, or appropriate hepatitis B post-exposure prophylaxis, in accordance with contemporary medical standards, before clinical onset;

Note: post-exposure prophylaxis is defined in the Schedule 1 - Dictionary.

1.           taking an immunosuppressive medication in the 5 years immediately preceding clinical worsening of chronic hepatitis B infection;

Note: Examples of immunosuppressive medications include corticosteroids other than inhaled or topical corticosteroids, medications used to prevent transplant rejection, tumour necrosis factor-α inhibitors and chemotherapeutic agents used for the treatment of cancer.

1.           having infection with human immunodeficiency virus before clinical worsening of chronic hepatitis B infection;
2.           having a solid organ transplant (excluding corneal transplant), stem cell transplant or bone marrow transplant before clinical worsening of chronic hepatitis B infection;
3.           undergoing a course of radiotherapy for cancer, where the liver was in the field of radiation, before clinical worsening of chronic hepatitis B infection;
4.       for females only, drinking at least 55 kilograms of alcohol in the 10 years immediately preceding clinical worsening of chronic hepatitis B infection;

Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

1.       for males only, drinking at least 110 kilograms of alcohol in the 10 years immediately preceding clinical worsening of chronic hepatitis B infection;

Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

1.       having diabetes mellitus for at least the 5 years before clinical worsening of chronic hepatitis B infection;
2.       undergoing surgical resection of hepatocellular carcinoma in the 2 years immediately preceding clinical worsening of chronic hepatitis B infection;
3.       being pregnant or within the 6 month postpartum period at the time of clinical worsening of chronic hepatitis B infection;
4.       having severe hepatic iron overload at the time of clinical worsening of chronic hepatitis B infection;

Note: iron overload is defined in the Schedule 1 - Dictionary.

1.       having chronic schistosomiasis involving the liver before clinical worsening of chronic hepatitis B infection;
2.       having hepatitis A, hepatitis C, hepatitis D or hepatitis E infection before clinical worsening of chronic hepatitis B infection;
3.       inability to obtain appropriate clinical management for hepatitis B infection before clinical worsening.

1.            Relationship to service
   1.           The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.
   2.           The factors set out in subsections 9(6) to 9(18) apply only to material contribution to, or aggravation of, hepatitis B infection where the person's hepatitis B infection was suffered or contracted before or during (but did not arise out of) the person's relevant service.
2.            Factors referring to an injury or disease covered by another Statement of Principles

In this Statement of Principles:

1.           if a factor referred to in section 9 applies in relation to a person; and
2.           that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA;

then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.

Schedule 1 - Dictionary  

Note:               See Section 6

1               Definitions

In this instrument:

                                clinical onset means the point backwards in time from the first date of confirmation of laboratory evidence of hepatitis B serological or nucleic acid markers, to the date at which the symptoms of hepatitis B were persistently present, as assessed by a registered medical practitioner.

                               hepatitis b infection—see subsection 7(2).

                               iron overload means an accumulation of excess iron in tissues and organs which has been confirmed by elevated ferritin or transferrin saturation levels. Causes include haemochromatosis and blood transfusions.

                               MRCA means the Military Rehabilitation and Compensation Act 2004.

                               post-exposure prophylaxis means providing immunoglobulin or a vaccine to a person who has been exposed to an infectious agent, in an effort to prevent them from developing the disease.

                               relevant service means:

(a)          operational service under the VEA;

(b)          peacekeeping service under the VEA;

(c)          hazardous service under the VEA;

(d)          British nuclear test defence service under the VEA;

(e)          warlike service under the MRCA; or

(f)           non-warlike service under the MRCA.

Note: MRCA and VEA are defined in the Schedule 1 - Dictionary.

                               terminal event means the proximate or ultimate cause of death and includes the following:

(a)           pneumonia;

(b)           respiratory failure;

(c)           cardiac arrest;

(d)           circulatory failure; or

(e)           cessation of brain function.

                               VEA means the Veterans' Entitlements Act 1986.