Statement of Principles concerning accommodation disorder (Reasonable Hypothesis) (No. 21 of 2026)

This instrument, the Statement of Principles (SoP) concerning Accommodation Disorder (Reasonable Hypothesis) (No. 21 of 2026), is a legislative instrument made under subsection 196B(2) of the Veterans' Entitlements Act 1986 (VEA). It replaces the previous SoP on accommodation disorder (No. 38 of 2017) and comes into effect on 23 March 2026. The purpose of an SoP is to prescribe the factors that must exist to raise a reasonable hypothesis connecting a specific injury, disease, or death with the relevant service rendered by veterans, peacekeepers, or members of the Forces under the VEA or the Military Rehabilitation and Compensation Act 2004 (MRCA). It does not create a right to compensation itself, but it sets the evidentiary standard for claims where the standard of proof is the reasonable hypothesis test under section 120A of the VEA or section 338 of the MRCA. In practical terms, the SoP operates as a gatekeeper: if a claimant with relevant service suffers from accommodation disorder, and at least one of the listed factors in section 9 is present and related to that service, then a reasonable hypothesis is deemed to have been raised, and the decision-maker must then determine whether the claim is accepted under the relevant Act. Mechanically, the SoP repeals the earlier 2017 version, which means any claims lodged after 23 March 2026 will be assessed against the new factors and definitions. The instrument also tightens certain definitions, particularly the exclusion of processes primarily affecting the lens or shape of the eyeball, such as presbyopia and cataract, which were already excluded in the earlier version but are now more clearly delineated. It also expands the list of medications that can trigger a factor if they cannot be ceased or substituted. The SoP is binding on the Repatriation Commission, the Military Rehabilitation and Compensation Commission, and the Veterans' Review Board, and it provides a standard that claimants and their representatives can rely upon to structure their evidence.

The central concept is "accommodation disorder", defined by section 7(2) as the inability to adjust the lens of the eye to various distances or an inability to sustain such an adjustment. Critically, the definition expressly excludes accommodative excess, processes primarily affecting the lens (presbyopia and cataract) or shape of the eyeball (myopia, hypermetropia, astigmatism), and reversible paralysis of ciliary muscle function by pharmacological agents unless those agents cannot be ceased or substituted. This means that common age-related presbyopia or refractive errors are not covered; the disorder must be a true accommodation deficit arising from neural or muscular dysfunction. The instrument uses ICD-10-AM code H52.5 for reference but clarifies that the legal definition in the SoP governs, not the code. Another key concept is "relevant service", defined in the Schedule 1 dictionary to include operational service, peacekeeping service, hazardous service, and British nuclear test defence service under the VEA, as well as warlike and non-warlike service under the MRCA. This determines which claimants can use this SoP. The factors that must exist are listed in section 9: having an injury or disorder affecting the oculomotor nerve or ciliary muscle of the affected eye; having concussion; having moderate to severe traumatic brain injury; taking atropine or an atropine-like medication where the medication cannot be ceased or substituted; taking a medication from the specified list where it cannot be ceased or substituted; taking any medication that both caused the disorder during therapy and saw it cease upon discontinuation; or inability to obtain appropriate clinical management before clinical worsening. The concept of "clinical onset" and "clinical worsening" is important: for most factors the condition must be present at the time of clinical onset or worsening. Section 10 clarifies that the factors must be related to the person's relevant service, and that the clinical worsening aspect applies only to material contribution to or aggravation of a condition that existed before or during service but did not arise out of service. The SoP also introduces the concept of "terminal event" in the dictionary, which includes pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function, used when death from accommodation disorder is claimed. Finally, section 11 provides that if a factor refers to an injury or disease covered by another SoP, the factors in that other SoP apply as in force from time to time, creating a cross-referencing mechanism.

The primary affected group is veterans, members of the Peacekeeping Forces, and members of the Forces under the VEA who have rendered relevant service, as well as members under the MRCA with warlike or non-warlike service. This includes current and former Australian Defence Force personnel and those who served in peacekeeping missions or British nuclear tests. Claimants who suffer from accommodation disorder as defined and believe it is connected to their service will rely on this SoP to establish a reasonable hypothesis. The instrument also affects their families and dependents if a death claim is made. Beyond claimants, the SoP directly impacts decision-makers within the Department of Veterans' Affairs and the Military Rehabilitation and Compensation Commission, who must apply the SoP when assessing liability. The Veterans' Review Board and the Administrative Appeals Tribunal will also use it as the binding standard in reviews. Legal practitioners, advocates, and representatives who assist veterans must understand the precise definitions and exclusions to advise on claim viability. Medical professionals, particularly ophthalmologists, optometrists, and neurologists, are affected because they will be asked to provide evidence on whether a patient meets the definition of accommodation disorder and whether any of the factors apply, such as concussion, traumatic brain injury, or medication use. The specified list of medications (over 80 entries) means that prescribing doctors may inadvertently create a causal pathway if the medication cannot be ceased or substituted; this may influence clinical decisions for veteran patients. The instrument also indirectly affects the broader veterans' compensation system by potentially increasing or decreasing the number of successful claims depending on how the new factors compare to the 2017 version. Because the SoP is legally binding, it reduces discretion; decision-makers must accept a reasonable hypothesis if a factor is present and related to service, even if medical opinion is divided. This shifts the battleground to factual disputes about whether the factor exists and whether it is related to service.

The SoP does not impose duties on individuals; rather, it grants a right to have a claim assessed using these specific factors. Claimants have the right to argue that at least one of the factors in section 9 exists and is related to their relevant service, and if that is established, the decision-maker must accept that a reasonable hypothesis has been raised. This is a significant evidentiary advantage: the standard is relatively low, requiring only a hypothesis that is not impossible, too remote, or tenuous. The right applies only when the claim is made under the relevant provisions of the VEA or MRCA, and only for accommodation disorder as strictly defined. The instrument imposes a duty on decision-makers to apply the SoP as a binding template. They cannot reject a claim solely because medical science generally does not support a link if the specific factor is present. Conversely, if none of the factors apply, the claim must be refused at the reasonable hypothesis stage. Claimants have a corresponding obligation to produce evidence that at least one factor exists. For example, if relying on factor 9(4) (atropine-like medication that cannot be ceased or substituted), the claimant must show not only that the medication was taken but also that it could not be ceased or substituted - a potentially difficult evidentiary burden. Similarly, for factor 9(5) (medication from the specified list), the same "cannot be ceased or substituted" condition applies. This is a key limitation: many medications on the list are used intermittently or can be switched to alternatives. The right to rely on factor 9(6) (other medication causing and resolving disorder) does not have that cessation condition but requires both development during therapy and cessation upon discontinuation, which may be hard to prove if the disorder persists after stopping the drug. Claimants also have the right to argue that clinical worsening was due to inability to obtain appropriate clinical management (factor 9(7)), but this only applies to material contribution or aggravation, not to the initial onset. Section 10(2) makes clear the clinical worsening factor does not apply if the condition arose out of service originally. The cross-reference mechanism in section 11 gives claimants the right to rely on other SoPs if a factor refers to an injury or disease covered by another instrument, effectively incorporating those factors by reference.

This instrument does not create any criminal penalties or civil monetary penalties. It is a beneficial piece of legislation designed to facilitate claims, not to punish. Enforcement is not a relevant concept in the traditional sense; rather, the SoP is enforced through the claims process. If a decision-maker fails to apply the SoP correctly, a claimant can seek review by the Veterans' Review Board, the Administrative Appeals Tribunal, or ultimately the Federal Court. The instrument is binding, so an error in applying the factors or definitions would be a reviewable error. The only potential penalty-related issue concerns fraud: if a claimant knowingly provides false evidence about a factor (e.g., claiming they took a specified medication when they did not, or falsely stating it cannot be ceased), they could be liable for offences under the Criminal Code or provisions of the VEA concerning false statements. However, such consequences flow from general law, not from this specific SoP. The Repatriation Medical Authority has no enforcement role; its function ends once the SoP is determined and registered. The practical enforcement mechanism is the requirement that the factors must be related to relevant service; if the relationship is not established, the claim fails. The instrument also implicitly enforces medical-scientific standards through its definitions. For example, excluding presbyopia and cataract means that decision-makers must ensure the claimed condition truly meets the definition; if a claimant's condition is primarily presbyopia, the SoP cannot be used. Similarly, the exclusion of reversible paralysis from pharmacological agents unless they cannot be ceased or substituted means that if the ciliary muscle paralysis is reversible and the medication can be stopped, the factor does not apply. This creates a de facto enforcement of diagnostic accuracy.

The SoP is made under subsection 196B(2) of the VEA, so its legal force derives from that Act. It applies to claims to which section 120A of the VEA or section 338 of the MRCA applies. Section 120A VEA sets out the standard of proof for claims relating to operational service: the Repatriation Commission must determine that the injury or disease is related to service unless it is satisfied beyond reasonable doubt that there is no sufficient ground for making that determination. The SoP provides the framework for what constitutes a reasonable hypothesis under that section. If a factor in section 9 exists and is related to service, a reasonable hypothesis is raised, and the decision-maker must then consider whether there is any contrary proof beyond reasonable doubt. Under the MRCA, section 338 similarly applies the reasonable hypothesis standard for warlike and non-warlike service. The SoP thus interacts with both Acts by providing the medical-scientific basis for the hypothesis. It also interacts with other Statements of Principles through section 11, which externalises factors: if a factor in this SoP refers to an injury or disease covered by another SoP, the factors in that other SoP apply as in force from time to time. This means that a claimant may need to satisfy a chain of factors across multiple SoPs. For example, factor 9(1) refers to an injury or disorder affecting the oculomotor nerve or ciliary muscle; that injury itself may be a separate disease for which another SoP exists (e.g., traumatic brain injury or multiple sclerosis). The terms and cross-references can become complex. The SoP also interacts with the general law of evidence and administrative law, as decisions on whether a factor exists are factual determinations that must be supported by material before the decision-maker. The instrument does not override state or territory workers' compensation laws, but it operates alongside the military compensation scheme. It does not affect private insurance or civil liability claims. The repeal of the 2017 SoP means that any claim determined after commencement must use this new instrument; however, transitional provisions in the VEA may apply to claims already lodged but not yet determined, but that is not addressed in this SoP itself. The SoP is also subject to the Legislation Act 2003 for registration and tabling, but that is procedural.

This SoP (No. 21 of 2026) is a replacement for the earlier Statement of Principles concerning accommodation disorder (Reasonable Hypothesis) (No. 38 of 2017), which was registered on the Federal Register of Legislation as F2017L00888. The earlier SoP is repealed in full by section 4 of the new instrument. The new instrument was determined on 20 February 2026 by the Repatriation Medical Authority and commences on 23 March 2026. The stated basis for the new determination is that the Repatriation Medical Authority is of the view that there is sound medical-scientific evidence indicating that accommodation disorder and death from accommodation disorder can be related to relevant service (section 8). The authority likely reviewed new medical literature since 2017 and adjusted the factors accordingly. Notable changes from the 2017 version (not explicitly stated but inferable from the text) include: the exclusion of accommodative excess is now explicit; the list of medications in the specified list appears to have been expanded (e.g., the 2026 list includes many more entries than one would expect from a 2017 list, but without the earlier list we cannot compare precisely); the condition that medications must be "where the medication cannot be ceased or substituted" is present for factors 9(4) and 9(5), which may be a refinement. The 2017 version likely had a similar structure, but the precise wording may have been narrower. The inclusion of "concussion" as a separate factor (9(2)) and "moderate to severe traumatic brain injury" (9(3)) may be new, reflecting evolving evidence on the effects of mild and moderate TBI on accommodation. The cross-reference mechanism in section 11 may also be more explicit now. Because the instrument is self-contained, the only amendment history visible is the repeal of the predecessor. Any future amendments would require a new SoP determined by the Repatriation Medical Authority under the same legislative power. There is no provision for partial amendment; the entire SoP is replaced.

The instrument itself does not reference any litigation, and no cases are named. However, Statements of Principles generally have been the subject of extensive litigation in the Administrative Appeals Tribunal, the Federal Court, and the High Court. The key legal issue with SoPs is the proper construction of the definitions and factors and the application of the reasonable hypothesis test. For accommodation disorder specifically, there has been litigation under the 2017 SoP, likely concerning whether a condition falls within the definition (e.g., distinguishing from presbyopia) and whether certain medications meet the criteria. With this new SoP, new litigation may arise around the "cannot be ceased or substituted" condition, which is a high threshold on its face. Claimants may argue that a medication cannot be ceased because there is no therapeutically equivalent alternative, or that a substitution would cause other medical harm. The exclusion of accommodative excess may also be contested, as the line between disorder and excess may be fact-dependent. The definition of "injury or disorder affecting the function of the oculomotor nerve or ciliary muscle" is broad but will require evidence of pathological process causing impairment. Litigation may also test the cross-reference to other SoPs under section 11, and whether the external factors must be satisfied as at the date of the original claim or the date of the decision. Because the Repatriation Medical Authority must have regard to sound medical-scientific evidence, claimants may seek to challenge the SoP itself on the basis that it does not reflect current evidence, but such challenges must be made in the context of a specific claim and are difficult to sustain given the statutory discretion of the Authority. The Federal Court has held that SoPs are legislative instruments and can be reviewed for jurisdictional error if the Authority misapplied its power. However, the merits of the factors are generally not reviewable. Practitioners should watch for decisions from the AAT that interpret the new definitions.

Several traps in this instrument can catch both claimants and decision-makers. First, the definition of accommodation disorder is narrow. It excludes processes primarily affecting the lens (presbyopia, cataract) and shape of the eyeball (myopia, hypermetropia, astigmatism). A claimant who presents with difficulty focusing on near objects due to age-related presbyopia will not qualify. The condition must be a true accommodation deficit arising from neural or muscular dysfunction. Second, the exclusion of reversible paralysis of ciliary muscle function by pharmacological agents means that if the condition is caused by eye drops used for examination (e.g., cyclopentolate) and the effect wears off, it is not covered unless the medication cannot be ceased or substituted. This is a high bar. Third, the factors that rely on medication (9(4) and 9(5)) require that the medication "cannot be ceased or substituted". This means the claimant must prove that no safe alternative exists or that ceasing the medication would cause unacceptable harm. This is likely to be heavily contested. Fourth, factor 9(6) (other medication) requires that the accommodation disorder developed during medication therapy and ceased upon discontinuation. If the disorder persists after stopping the drug, this factor cannot be used. Fifth, factor 9(7) (inability to obtain appropriate clinical management before clinical worsening) applies only to worsening, not initial onset. Even then, the worsening must be material and related to the inability. Sixth, the clinical worsening aspect under section 10(2) applies only if the condition was suffered or contracted before or during service but did not arise out of service. If the condition arose out of service, the worsening factor does not apply. Seventh, the cross-reference in section 11 can create a chain of requirements. For example, factor 9(1) requires an injury or disorder affecting the oculomotor nerve or ciliary muscle; that injury may itself need to be related to service under its own SoP, which may introduce additional factors that the claimant cannot satisfy. Eighth, the specified list of medications is fixed and does not include all anticholinergic drugs. If a claimant is taking a medication that has anticholinergic effects but is not on the list and does not meet the factor 9(6) criteria (because it did not cause the disorder or it did not resolve upon cessation), it cannot be used. Ninth, the SoP only applies to claims under s 120A VEA or s 338 MRCA; it does not apply to other compensation schemes such as the Safety, Rehabilitation and Compensation Act 1988 (SRCA) or the Military Rehabilitation and Compensation (Consequential Amendments) Act 2004 for certain types of service. Tenth, the instrument defines "terminal event" broadly, but the condition must be contributed to by the accommodation disorder. If the accommodation disorder is mild and the death is from an unrelated cause, the claim will fail.

For a claimant seeking to use this SoP to support a claim for accommodation disorder, the compliance path involves gathering medical evidence that addresses each element. First, obtain a definitive diagnosis from an ophthalmologist or optometrist confirming that the condition meets the definition in section 7(2). The diagnosis must rule out presbyopia, cataract, myopia, hypermetropia, astigmatism, and accommodative excess. A report should explicitly state that the patient has a true accommodation disorder, not a refractive error or age-related lens change. Second, identify the relevant service: the claimant must have rendered operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, or warlike/non-warlike service under the MRCA. The service records must be pulled. Third, identify which factor in section 9 potentially applies. The most common may be factor 9(1) - an injury or disorder affecting the oculomotor nerve or ciliary muscle. This requires evidence of a pathological process affecting the brain stem, oculomotor nerve, or ciliary muscle, such as traumatic brain injury, stroke, infection, or demyelinating disease. If concussion or moderate to severe traumatic brain injury is present, factors 9(2) or 9(3) may apply; require evidence of the diagnosis and timing. For medication-related factors, compile a complete medication history. If the medication is on the specified list or is atropine-like, obtain a medical opinion that the medication cannot be ceased or substituted. This may require a specialist opinion from the prescribing physician that alternatives are not appropriate due to side effects, efficacy, or contraindications. If the medication is not on the list, rely on factor 9(6) and produce evidence of temporal relationship: onset during therapy and resolution upon cessation. For inability to obtain appropriate clinical management, document what clinical management was recommended, why it was not obtained, and how this led to worsening. Fourth, ensure that the factor is related to the claimant's relevant service. For example, if the injury causing oculomotor nerve dysfunction occurred during service, document the incident. If a medication was prescribed for a service-related condition, establish that link. Fifth, for death claims, provide evidence that the accommodation disorder contributed to the terminal event. The report from a medical examiner should address causation. Sixth, comply with the standard of proof: the claimant only needs to raise a reasonable hypothesis, not prove causation on the balance of probabilities. Therefore, the evidence does not need to be definitive, but it must be more than speculative. Decision-makers should be provided with a clear summary showing which factor is met, the supporting medical evidence, and the relationship to service. Practitioners should also check if any cross-referenced SoPs are needed under section 11 and ensure those factors are also satisfied. Finally, note that this SoP replaces the 2017 version; if a claim was already lodged but not yet determined, the applicable SoP is generally the one in force at the time of the decision, so the new SoP should be used if the decision is made after 23 March 2026.