Statement of Principles concerning acute infectious mononucleosis (Reasonable Hypothesis) (No. 17 of 2021)

The SOP builds around a small set of interlocking legal and medical concepts that determine when a claim for acute infectious mononucleosis or death from it can be said to have a reasonable hypothesis of connection to relevant service.

Definition of the condition. Acute infectious mononucleosis, for these purposes, is explicitly defined as an illness caused by infection with Epstein-Barr virus accompanied by laboratory evidence of recently acquired EBV infection (s7(2)). The text goes further by noting typical clinical features (pharyngitis, lymphadenopathy, splenomegaly, fever, fatigue, myalgia and atypical lymphocytosis) as descriptive aids (s7(2) note). While the ICD-10-AM code B27.0 is cited (s7(3)), the SOP makes clear that the statutory meaning is the definition in s7(2) and not the mere presence of that code (s7(3)-(4)).

Laboratory evidence requirement. The definition conditions the illness on laboratory confirmation of recent EBV infection. The SOP does not specify particular laboratory tests or cut‑offs; it imposes an evidential requirement that clinical diagnosis be accompanied by laboratory evidence of recently acquired infection (s7(2)). That requirement is a gatekeeping concept: absent laboratory evidence of recent EBV infection, the condition will not meet the SOP’s definition.

Exposure timing window. One of the two discrete factors that can raise the reasonable hypothesis is defined timing of exposure to EBV: exposure must have occurred between 12 and 50 days before clinical onset of the illness (s9(1)). The Schedule gives a concrete meaning to exposure: either exposure of oral mucosa to EBV‑infected saliva, or receipt of infected blood products, stem cells or organs (Schedule 1 definition of being exposed). The 12-50 day window therefore is the temporal mechanism linking exposure events to clinical onset for claims purposes.

Clinical management factor. The alternative factor is an inability to obtain appropriate clinical management for the condition (s9(2)). The SOP does not define “appropriate clinical management” within the text, but it constrains the application of this factor by requiring that it be related to relevant service (s10(1)) and, per s10(2), applies only to material contribution to or aggravation of acute infectious mononucleosis where the condition was suffered or contracted before or during, but did not arise out of, the relevant service. Thus the management factor is narrowly framed as a service-related failure to access appropriate care that materially contributes to or aggravates the condition.

Relation to service. The SOP’s purpose is to determine when a reasonable hypothesis exists connecting the condition to relevant service; accordingly it insists that any enumerated factor must be related to the person’s relevant service (s10(1)). “Relevant service” is a defined term in the Schedule and covers categories under the VEA (operational, peacekeeping, hazardous, British nuclear test defence service) and the MRCA (warlike and non‑warlike service) (Schedule 1).

Death and terminal events. For death claims, acute infectious mononucleosis includes death from a terminal event or condition that was contributed to by the person’s acute infectious mononucleosis (s7(5)). The Schedule specifies examples of terminal events,pneumonia, respiratory failure, cardiac arrest, circulatory failure, and cessation of brain function,thereby providing a defined list of proximate causes the Authority considered relevant for linking death to the condition (Schedule 1).

Interaction with other SOPs. If a factor in s9 refers to an injury or disease covered by another SOP, the other SOP’s factors apply as in force from time to time (s11). This is a legal mechanism for managing overlaps and sequential dependencies between Statements of Principles.

Standard of connection. The SOP is explicit that it identifies the factors that must minimally exist before it can be said that a reasonable hypothesis has been raised (s9). It therefore sets an evidential threshold for administrative decision-makers assessing whether the statutory threshold for further consideration of a claim is met.

Authority and evidential basis. The Authority records that it is of the view there is sound medical‑scientific evidence indicating possible relation between the condition and relevant service (s8). That statement functions as the Authority’s declaratory justification for issuing the SOP under the statute cited (s3), but the instrument itself sets the factors and definitional constructs that attach to that view.

Direct claimants. The primary persons affected are veterans and serving members whose claims for compensation, repatriation or related benefits fall within the application of section 120A of the VEA or section 338 of the MRCA (s5). The Schedule’s definition of “relevant service” makes explicit that the SOP applies across multiple service categories: operational service, peacekeeping service, hazardous service and British nuclear test defence service under the VEA, and warlike and non‑warlike service under the MRCA (Schedule 1). Thus claimants in those service classes who assert acute infectious mononucleosis, or death from it, will be assessed with reference to this SOP.

Decision-makers and administrators. The SOP is a tool for administrative decision-makers who assess whether a “reasonable hypothesis” exists connecting the medical condition to service. The instrument sets the minimal factors that these decision-makers must look for to conclude a reasonable hypothesis is raised (s9). Although the instrument does not expressly name the decision-making body that will apply it, it is made under the VEA framework (s3, s5), and the SOP’s provisions determine the medical evidence required in the statutory claims processes.

Medical practitioners and laboratories. Clinicians providing diagnoses, laboratory tests and medical reports will be directly implicated because the SOP conditions the defined illness on laboratory evidence of recently acquired EBV infection (s7(2)). Laboratories and treating clinicians must produce records that establish recent infection timing if a claimant is to rely on the laboratory evidence requirement. The Schedule’s definition of exposure by transfusion or transplant also brings blood services, transplant teams and their records into evidentiary focus for particular claims.

Claims representatives and advisers. Lawyers, advocates, and advisers preparing claims will need to structure evidence around the factors in s9 and the definitions in the Schedule. They must collect documentation establishing the timing of exposure relative to onset (12-50 days window), laboratory confirmation of recent EBV infection, any evidence of inability to obtain appropriate clinical management, and proof that the factor is related to relevant service (s9, s7(2), s10).

Next-of-kin and estate representatives. For death claims, the SOP’s inclusion of death caused by a terminal event that was contributed to by acute infectious mononucleosis expands the population of persons who may bring or be affected by claims. Estates and next-of-kin pursuing such claims must assemble evidence linking the terminal event listed in the Schedule to prior EBV infection and to relevant service circumstances (s7(5), Schedule 1).

Other SOPs and overlapping conditions. The SOP affects administrators and claimants in circumstances where factors refer to other injuries or diseases that have their own SOPs. Section 11 requires that, where a s9 factor refers to a condition covered by another SOP, the other SOP’s factors apply. That arrangement can affect claim strategy and evidence-gathering where overlapping conditions are alleged.

No direct private civil obligations created. The instrument does not itself impose duties on private entities outside the claims process, nor does it create criminal penalties. However, the Schedule’s definition of being exposed to EBV by transfusion or transplant means that events in medical settings,blood transfusions, organ or stem cell transplants,are implicated insofar as they may provide proof of exposure relevant to claims. The instrument does not specify remedies, tort liability, or regulatory consequences for those medical services; it limits its legal effect to the VEA/MRCA claims context (s5).

This SOP does not create freestanding civil liabilities or criminal offences. Instead it describes the factors that decision-makers must treat as sufficient to raise a reasonable hypothesis under the VEA and MRCA claims processes and so affects duties and rights within those statutory schemes.

Duty to apply the Statement in relevant claims. Administrative decision-makers handling claims under section 120A of the VEA or section 338 of the MRCA must apply the SOP to determine whether a reasonable hypothesis has been raised. The instrument sets the minimal evidential factors to be considered when assessing the connection between acute infectious mononucleosis (or death from it) and relevant service (s5, s9). The SOP thus imposes a procedural requirement on decision-makers to check for the presence or absence of the listed factors.

Right to have claims assessed against the stated factors. Claimants have the right, within the statutory claim processes, to have their case considered against the factors the Authority has specified. If at least one factor from s9 exists and is related to relevant service under s10, a reasonable hypothesis is, per the SOP’s terms, raised. The SOP therefore structures claimants’ evidential rights: claimants can seek to establish the presence of s9 factors to satisfy the reasonable hypothesis threshold.

Duty of proof in practice. While the SOP sets the minimal factors for raising a reasonable hypothesis, it also shifts evidential burdens in practice. The definition of the condition requires laboratory evidence of recently acquired EBV infection (s7(2)), so claimants must produce that evidence to have the condition fall within the SOP’s defined meaning. For the exposure factor, claimants must establish timing of exposure between 12 and 50 days before clinical onset (s9(1)). For the clinical management factor, claimants must show inability to obtain appropriate clinical management, and that this inability is related to relevant service and materially contributed to or aggravated the condition in the specified circumstances (s9(2), s10(2)). These requirements create practical duties for claimants to procure and present specific categories of evidence.

Duty to interpret ICD-10-AM reference in light of statutory meaning. The SOP notes that while the condition attracts ICD-10-AM code B27.0, the statutory meaning is the definition in s7(2) (s7(3)). Decision-makers must therefore treat the code as an identifier but apply the statutory definition when determining whether the condition is within the SOP.

Duty to apply other SOPs where relevant. Section 11 places a duty on decision-makers to apply factors from other SOPs where a s9 factor refers to an injury or disease covered by that other SOP. That mechanism imposes a coordination duty across Statements of Principles: decision-makers must consult and apply the other instrument’s terms “as in force from time to time” when the factual matrix triggers such overlap.

Rights in death claims. The instrument treats death from acute infectious mononucleosis as including death from a terminal event or condition that was contributed to by the person’s acute infectious mononucleosis (s7(5)). The Schedule identifies examples of terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). Estates or dependants claiming death-related benefits have the right to rely on this definition in assembling evidence linking death to antecedent EBV infection and to relevant service.

No affirmative enforcement penalties. The SOP contains no penalty provisions, fines or enforcement mechanisms within its text. Its operation is to inform administrative decisions under the VEA and MRCA. The Authority records it has formed the view that there is sound medical‑scientific evidence linking the condition with relevant service (s8), which supports the SOP’s application by decision-makers but does not itself create or enforce private duties outside the statutory claims system.

Duties of medical reporting and evidence. The practical effect is that clinicians, laboratories and hospitals may face demands from claimants or decision-makers for documentation that establishes recent EBV infection, exact timing of exposure and clinical onset, and records of attempts to obtain clinical management. The SOP’s text articulates what categories of evidence will be decisive within the SOP framework, thereby shaping submission requirements for claimants.

The instrument contains no provisions that create criminal offences, civil penalties, or direct regulatory sanctions within its text. Its legal effect is confined to the VEA/MRCA claims environment where the question is whether a reasonable hypothesis exists connecting acute infectious mononucleosis or death from it to relevant service. The SOP therefore operates as an administrative evidentiary tool rather than as an enforcement statute.

Administrative enforcement through claims decisions. Enforcement in the context of this SOP consists of administrative decisions by the bodies that process claims under the VEA or MRCA, which must apply the SOP’s factors when determining whether a reasonable hypothesis has been raised (s5, s9). If decision-makers find that none of the s9 factors exists, or that a factor does not relate to relevant service as required by s10, the reasonable hypothesis threshold will not be met and the claim will not progress on that basis. The instrument does not detail appeals processes, review rights, or sanctions; those procedural features remain within the relevant statutory frameworks (the VEA and MRCA), which are referenced by the SOP but not reproduced in it (s3, s5).

No express investigatory powers. The SOP does not allocate investigatory powers, compulsory evidence-gathering authority, or enforcement resources. It prescribes what factors decision-makers must consider and how the condition is to be defined for claims purposes. Any power to obtain records, compel medical examinations, or subpoena evidence would derive from the underlying VEA/MRCA claims processes and relevant administrative law, not from this instrument itself.

Risk of denial where evidence is lacking. Because the SOP requires laboratory evidence of recently acquired EBV infection (s7(2)) and specific timing of exposure (s9(1)) or evidence of inability to obtain appropriate clinical management (s9(2)), claimants who cannot produce those categories of evidence may have their claims rejected at the reasonable hypothesis stage. That outcome is the administrative consequence of failing to satisfy the evidential scaffolding the Authority has specified. The SOP does not provide for remedial exceptions or alternative evidential pathways within its text.

Interplay with other SOPs for enforcement outcomes. Where a s9 factor refers to a condition covered by another SOP, section 11 requires application of that other SOP’s factors. This can affect enforcement outcomes where overlapping conditions or cross-referred factors are present: decision-makers must follow the other SOP’s terms “as in force from time to time,” potentially changing the evidentiary threshold applicable to that part of the claim (s11).

No monetary penalties or criminal sanctions in the instrument. The SOP does not impose fines, imprisonment, or civil liability directly. It is an instrument intended to structure administrative adjudication. Any penalties or adverse legal consequences that flow from a claim being unsuccessful will arise under the wider VEA or MRCA framework or other applicable law, not from the SOP’s text.

Authority statement as justificatory evidence. Section 8 records the Authority’s view that there is sound medical‑scientific evidence indicating a relationship between acute infectious mononucleosis and relevant service. That statement is a justificatory element supporting the SOP’s issuance, but it does not itself function as an enforcement mechanism. Enforcement remains administrative application of the factors in claims decision-making.

Primary statutory anchors. The SOP is made under subsection 196B(2) of the Veterans' Entitlements Act 1986 (s3). It applies specifically to claims to which section 120A of the VEA or section 338 of the MRCA applies (s5). Those citations link the SOP to the VEA and MRCA statutory frameworks governing veterans’ entitlements and military rehabilitation and compensation. The SOP is an instrument that feeds into decision-making governed by those Acts.

Interaction with other Statements of Principles. The SOP contains an explicit coordination rule: if a factor in s9 refers to an injury or disease for which another Statement of Principles has been determined under subsection 196B(2) of the VEA, then the factors in that other SOP apply according to its terms (s11). That mechanism provides a legal pathway for overlapping medical conditions to be handled in accordance with the specific SOPs that the Authority has issued for them. The phrase “as in force from time to time” in s11 means decision-makers must apply the other SOP’s current terms, not necessarily the terms in force at the time of exposure or onset.

Definition versus ICD coding. The SOP notes that while acute infectious mononucleosis attracts ICD‑10‑AM code B27.0 (s7(3)), the meaning of the condition for the SOP is the statutory definition in s7(2). The instrument cites the ICD‑10‑AM edition and the publisher (s7(4)), but the operative definition is the instrument’s own description of EBV infection with laboratory evidence of recent infection. This clarifies that ICD coding is an identifying aid, not the substantive definitional basis.

Evidence generated in health and transplant law contexts. The Schedule’s definition of “being exposed to the Epstein-Barr virus” includes receiving infected blood transfusion, blood products, stem cell transplant or organ transplant (Schedule 1). That inclusion links the SOP to contexts governed by health regulation, blood product standards, transplantation practices, and hospital records. While the SOP does not change regulatory obligations in those fields, it makes events governed by those regimes potentially decisive evidence in VEA/MRCA claims involving EBV exposure.

Death claims and cause-of-death rules. For death claims, the SOP treats death from a terminal event or condition that was contributed to by acute infectious mononucleosis as within its scope (s7(5)). The Schedule specifies several terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). Those definitions interact with standard medico-legal cause-of-death determinations and may require pathologists’ reports and hospital records in claims; the SOP itself does not alter coroner or death certification law, but it frames how cause-of-death evidence will be used in VEA/MRCA adjudication.

Repeal of prior SOP. The instrument expressly repeals the Statement of Principles concerning acute infectious mononucleosis No. 3 of 2012 (s4). That repeal creates a legal sequencing: the 2021 instrument replaces the prior SOP in the Authority’s suite of Statements of Principles. The instrument does not include transitional clauses; any transitional treatment will depend on the underlying VEA/MRCA administrative practice or other statutory provisions not reproduced in the SOP.

No express interaction with criminal, tort or workplace compensation laws. The SOP is silent about tort liability, criminal sanctions, workers’ compensation regimes, or other non-VEA/MRCA statutory schemes. It therefore does not itself confer or remove civil causes of action against private parties or employers. Events such as transfusion-associated exposure may be evidence in those domains, but the SOP’s operation is limited to VEA/MRCA claims (s5).

Administrative law context. As an instrument made under the VEA, the SOP will operate within the broader administrative law framework governing validity, procedural fairness and review. The instrument itself contains a statement of the Authority’s view of medical‑scientific evidence (s8) and a set of factors and definitions binding administrative assessments. Any legal challenges to decisions applying the SOP would engage the source statute and administrative law principles, but the SOP does not itself set review routes or judicial procedures.

This instrument is identified as Statement of Principles No. 17 of 2021 and is dated 24 December 2020 (front page). It commences on 25 January 2021 (s2). The instrument explicitly repeals the earlier Statement of Principles concerning acute infectious mononucleosis No. 3 of 2012 (Federal Register of Legislation No. F2012L00007) as made under subsection 196B(2) of the VEA (s4). The SOP therefore represents the Authority’s replacement of its 2012 instrument with a revised set of definitions and factors.

The text provides no additional amendment schedule, savings or transitional provisions. It does not set out any staged implementation measures or grandfathering of claims lodged under the prior SOP. The procedural application clause simply states that the instrument “applies to a claim to which section 120A of the VEA or section 338 of the MRCA applies” (s5). The absence of transitional text in the SOP means that any transitional handling of claims across the repeal will be a matter for the claim-processing bodies operating under the VEA and MRCA, and any such approach is not described in the instrument itself.

The instrument’s Schedule supplies definitional particulars and repeats statutory cross-references, including definitions of MRCA and VEA themselves (Schedule 1). The Authority’s recorded view that sound medical‑scientific evidence supports a link between acute infectious mononucleosis and relevant service is set out in s8. That statement is presented as the evidentiary foundation for issuing the present SOP, but the instrument does not outline the research or documents underlying the Authority’s view, nor does it attach an explanatory memorandum or scientific annex within the text provided.

Because the SOP replaces the 2012 version, parties wishing to understand what changed in substance must compare the 2012 instrument to the 2021 instrument. The instrument itself does not include an amendment history table or a list of differences relative to the repealed instrument. The only explicit amendment act recorded in the instrument is the repeal in s4 and the making of this instrument under the Authority’s statutory power in s3.

No subsequent amendments to this instrument are recorded within the text provided. Any future amendments would be made under the same enabling provision (subsection 196B(2) of the VEA) and would presumably be recorded as new instruments and reflected on the Federal Register of Legislation or in the Authority’s instrument register. The SOP as presented is the operative instrument from 25 January 2021 until any later instrument expressly repeals or amends it.

The instrument as provided contains no references to litigation, cases, judicial decisions, or prior administrative rulings. It does not cite any tribunal or court authority, nor does it report any legal challenges to its terms or to the earlier 2012 Statement of Principles that it repeals. The SOP therefore contains no embedded litigation history or judicial gloss within its text.

However, the SOP creates several precise factual and definitional constructs that are plausibly contestable in claims processes and therefore loci for potential litigation. The instrument identifies laboratory evidence of recently acquired EBV infection as integral to the statutory meaning of the condition (s7(2)). Disputes could arise in practice over the sufficiency, interpretation, or timing of laboratory tests. The SOP does not define which tests, which serological markers, or what timeframes constitute “recently acquired” infection. That evidential indeterminacy, as reflected in the instrument itself, can be a focal point for claimants and decision-makers and may lead to contested administrative determinations where judicial review is sought, although the instrument does not document such litigation.

The 12-50 day exposure window in s9(1) is another precise temporal parameter that decision-makers must apply. In cases where exposure timing is uncertain or where records are absent, parties may dispute whether the exposure falls within that window. The Schedule definition of exposure includes oral mucosa contact with infected saliva and receipt of infected blood products or transplants; factual disputes about whether an exposure event occurred, or whether a transfusion product was infected, could also become contested issues in claims.

Section 9(2) and section 10(2) establish more nuanced factual requirements for the “inability to obtain appropriate clinical management” factor: it applies only where the condition was suffered or contracted before or during, but did not arise out of, the relevant service, and the inability made a material contribution to or aggravated the condition (s10(2)). Determining whether a failure to obtain care is “appropriate,” whether the failure is causally material, and whether it is sufficiently related to service are factual and legal questions that could generate litigation over interpretation and application.

Section 11’s cross-reference rule can produce disputes where more than one SOP is potentially engaged. If a s9 factor refers to an injury covered by another Statement of Principles, then the other SOP’s factors apply “as in force from time to time” (s11). Litigation could potentially arise over which SOP is applicable, whether the cross-referenced SOP’s current terms should be applied, or how to reconcile differing factor lists between instruments.

While the instrument does not record litigation, the areas outlined above are the mechanics within the SOP that create adjacency to contested decision-making. Any actual litigation history concerning this SOP, its predecessor, or decisions applying these provisions would appear in administrative law reports, tribunal records, or court registries; the SOP itself does not cite or summarise such material.

Several features of the SOP can produce practical pitfalls for claimants, clinicians and decision-makers because they set narrowly framed evidential or temporal rules.

Laboratory evidence requirement is essential and undefined in detail. The statutory definition conditions the illness on laboratory evidence of recently acquired EBV infection (s7(2)). The SOP does not specify which tests satisfy that requirement, how recent the infection must be for laboratory markers, nor what thresholds or combinations of serology or PCR constitute “recently acquired.” Claimants without contemporaneous laboratory records may fail to meet this core definitional requirement. Clinicians and advocates should not assume clinical features alone are sufficient for this SOP’s meaning.

The exposure timing window is narrow and mandatory. A discrete exposure window of between 12 and 50 days before clinical onset is set out as an explicit factor (s9(1)). Claims relying on exposure outside that window cannot rely on s9(1). Claimants who cannot document an exposure date with sufficient precision risk the inability to satisfy this factor. Where exposure is alleged by contact with saliva, dating the contact to fall within a 12-50 day window requires specific contemporaneous records or admissible evidence.

“Being exposed” routes are particular. The Schedule defines being exposed to EBV as either exposure of oral mucosa to saliva infected with EBV or receiving infected blood transfusion, blood products, stem cell transplant or organ transplant (Schedule 1 definition). Exposure alleged through other routes is not encompassed by the SOP’s definition and therefore will not meet s9(1) as drafted. Parties must map alleged exposures to these specific paths.

The clinical management factor is constrained by relation-to-service rules. Section 9(2) permits inability to obtain appropriate clinical management as a factor, but s10(2) limits its application to cases where the person’s EBV infection was suffered or contracted before or during, but did not arise out of, relevant service and the lack of management materially contributed to or aggravated the condition. This wording means that where the condition arose out of service (that is, where service caused the condition), inability to obtain clinical management is not the relevant factor for material contribution under s9(2). The caveat creates a counterintuitive limitation claimants and advisers must note.

ICD‑10‑AM code is not determinative. The SOP acknowledges the ICD‑10‑AM code B27.0 (s7(3)) but clarifies that the statutory meaning is the definition in s7(2). A coder’s assignment of B27.0 in a hospital record will not, on its own, satisfy the SOP’s definition if laboratory evidence of recent EBV infection is absent or if other factors are not satisfied. Practitioners should not rely on an ICD code as conclusive proof that the SOP’s definitional criteria are met.

Death claims depend on terminal event contribution. For death claims, the SOP requires that death be from a terminal event or condition that was contributed to by the person’s acute infectious mononucleosis (s7(5)). The Schedule lists certain terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). A death certificate listing one of those terminal events will still require evidence linking prior EBV infection to that terminal event. The causal chain must be established in claim evidence.

Cross-reference to other SOPs may change applicable factors. If a s9 factor refers to an injury or disease covered by another SOP, the other SOP’s factors apply “as in force from time to time” (s11). That creates a moving target: a factor that triggers a cross-referenced SOP may be judged under the latest version of that SOP, which can alter evidential requirements if the other SOP is amended.

No transitional provisions are provided in the instrument. The SOP repeals the 2012 SOP and comes into force on a set date (s2, s4). The instrument does not state how claims that were pending under the prior SOP will be treated. Claimants and administrators need to be alert to practice directions or administrative policies (outside the SOP) addressing transitional handling.

Ambiguities in unspecified terms. The SOP uses terms that are not exhaustively defined,“recently acquired,” “appropriate clinical management,” “clinical onset.” These undefined terms will require interpretation in practice. The SOP provides the framework but not the precise specifications; claimants should therefore gather as much contemporaneous clinical documentation as possible to reduce reliance on interpretive judgment.

No enforcement or penalty provisions. The SOP does not set penalties or enforcement mechanisms; it is an evidentiary statement for decision-makers. Parties expecting the SOP to create obligations enforceable against medical providers, blood services or hospitals will find that the SOP does not do so directly.

For claimants, legal representatives, clinicians and administrators aiming to comply with the SOP’s requirements and to present claims that meet the reasonable hypothesis threshold, the instrument prescribes specific categories of evidence and factual mapping. Below are practical compliance steps tied to the SOP text.

1. Establish laboratory evidence of recently acquired EBV infection (s7(2))

• Obtain and lodge contemporaneous laboratory reports showing markers consistent with recent EBV infection. The SOP requires laboratory evidence of recently acquired infection as part of the definition of the condition. While the SOP does not prescribe exact tests, typical clinical practice would suggest serological markers showing acute infection or PCR evidence of EBV; the SOP itself requires only that laboratory evidence of recently acquired infection exist. Where such records are absent, seek retrospective expert clinical evidence addressing the likelihood that the illness was EBV-related, but note that the SOP conditions the statutory meaning on laboratory confirmation.

2. Document exposure timing and mechanism if relying on s9(1)

• For claims based on exposure, compile evidence showing an exposure event that falls between 12 and 50 days before the clinical onset of symptoms (s9(1)). Precisely document the date(s) of exposure and the date of clinical onset. Exposure must map to the Schedule definition: either oral mucosa contact with EBV-infected saliva or receipt of infected blood products, stem cell or organ transplants (Schedule 1). Collect witness statements, clinical notes, hospital transfusion records, transplant documentation, and any laboratory testing of blood products or donors where available.

3. Document attempts to obtain clinical management if relying on s9(2)

• If the claim relies on inability to obtain appropriate clinical management, compile contemporaneous records demonstrating attempts to obtain care, the nature of the care sought, and the reasons care was unavailable or inappropriate. Also document how the failure to obtain management materially contributed to or aggravated the condition. Remember s10(2) constrains this factor: it applies only where the condition was suffered or contracted before or during, but did not arise out of, the relevant service. Ensure the claim materials address that temporal and causal limitation.

4. Link factors to relevant service (s10(1))

• Every factor asserted must be related to the claimant’s relevant service. Use service records, deployment rosters, medical records from service locations, orders, and contemporaneous incident reports to establish the nexus between the exposure or the inability to obtain care and the specified category of relevant service defined in the Schedule (operational, peacekeeping, hazardous, British nuclear test defence service; warlike or non‑warlike under the MRCA).

5. For death claims, demonstrate contribution to terminal event (s7(5) and Schedule)

• Where death is claimed, assemble medical records, pathology reports, hospital notes and, if available, coroner findings that show the terminal event (for example pneumonia, respiratory or circulatory failure) and evidence that the terminal event was contributed to by antecedent acute infectious mononucleosis. The SOP’s Schedule lists particular terminal events that the Authority considered relevant; evidence should address how prior EBV infection led to or materially contributed to the terminal event.

6. Cross-check for other applicable SOPs (s11)

• If the asserted factor refers to another illness or injury that is subject to its own SOP, identify that SOP and ensure the claim material also satisfies the other SOP’s factors, as those will apply “as in force from time to time” (s11). Obtain and include the current text of the cross-referenced SOP at the time of lodging the claim to avoid missing additional prescribed factors.

7. Use ICD coding as supportive, not definitive, evidence (s7(3)-(4))

• If hospital records carry ICD‑10‑AM code B27.0, include that documentation. But ensure laboratory evidence and the SOP’s defined meaning are addressed because the SOP states that the meaning for its purposes is the definition in s7(2) and not merely the ICD code.

8. Prepare for evidentiary gaps

• Where contemporaneous laboratory or exposure records are missing, secure expert medical opinions that explain the likely chronology, typical laboratory patterns for EBV infection and the plausibility of the exposure-onset link within the 12-50 day window. Recognise that the SOP sets minimum factors; evidentiary gaps may make it harder to raise a reasonable hypothesis.

9. Record and present service-related obstacles to care

• If relying on inability to obtain appropriate clinical management, compile administrative or service records that evidence systemic or situational barriers to care during relevant service (for example lack of access to medical facilities in theatre, interruptions to supply of blood products, or evacuation logs). These records will be vital to show the inability to obtain appropriate treatment was linked to service and materially contributed to the condition.

10. Organise a clear chronology and index of evidence

• Given the narrow temporal and definitional requirements, present a clear chronology showing dates of exposure, onset, laboratory testing, medical consultations, and any attempts to secure treatment. Index the evidence to the SOP’s sections: s7(2) for laboratory evidence; s9(1) for exposure timing; Schedule 1 for exposure modes and relevant service definitions; s9(2) and s10(2) for clinical management issues; s7(5) and Schedule for death claims.

11. Monitor for updated SOPs

• Section 11’s reference to other SOPs applying “as in force from time to time” implies that other Statements may be amended. Practitioners should check for current SOP versions when preparing claims and adapt evidence to any changed factors in cross-referenced SOPs.

Following these steps aligns evidence-gathering and claim presentation with the SOP’s textual requirements and reduces the risk that an administrative decision-maker will find that the minimal factors necessary to raise a reasonable hypothesis are unsupported.