Statement of Principles concerning acute pancreatitis (Reasonable Hypothesis) (No. 5 of 2020)

The instrument revolves around a small set of interlocking concepts that determine how a claim involving acute pancreatitis is assessed for service connection under the statutory reasonable hypothesis standard. The principal concepts are: the medical definition of acute pancreatitis; the reasonable hypothesis threshold; the specified list of factors that, singly, can satisfy that threshold; temporal windows and qualifications attached to particular factors; cross‑references to other Statements of Principles; and definitional detail in the Schedule.

Acute pancreatitis is defined in clinical terms as an acute inflammatory condition due to autodigestion of pancreatic tissue by its own enzymes (s 7(2)). The instrument expressly connects death from acute pancreatitis to terminal events or conditions to which the acute pancreatitis contributed (s 7(5)), and specifies that the ICD‑10‑AM K85 code is not determinative by itself , the statutory definition in s 7(2) controls application (s 7(3)-(4)).

The reasonable hypothesis device is operationalised in s 9. The instrument identifies 26 discrete factors, any one of which, if present and connected to the claimant’s relevant service, is sufficient to "raise a reasonable hypothesis" that their acute pancreatitis or death from it is related to service. The factors range from lifestyle exposures (smoking quantified as pack‑years, alcohol consumption quantified in grams/week using the Australian Standard of ten grams per standard drink) to clinical findings (cholelithiasis, biliary sludge), metabolic abnormalities (hypertriglyceridaemia > 11.3 mmol/L, hypercalcaemia), procedures and injuries with tight temporal windows (surgery within 30 days, trauma within seven days), specific infectious and envenomation causes, drug exposures and drug‑specific dechallenge criteria (s 9(1)-(26)).

Schedule 1 supplies critical definitions that change how the factors operate. Examples include the precise pack‑years calculation (Wording: one pack‑year equals twenty tailor‑made cigarettes per day for one year, equating to 7,300 cigarettes or about 7.3 kg of tobacco) and the list of specified drugs, procedures, organisms and agents (Schedule 1 definitions). Some factors are qualified , for example obesity as a factor applies only to "severe acute pancreatitis" (s 9(25)), and the instrument defines severe acute pancreatitis as requiring hospitalisation, or death from acute pancreatitis (Schedule 1).

Section 10 imposes a service relationship requirement: the existence of any factor in s 9 must be related to the person's relevant service (s 10(1)). Section 10(2) further limits the application of factor 9(26) (inability to obtain appropriate clinical management) to instances of material contribution or aggravation where the acute pancreatitis existed before or during, but did not arise out of, relevant service. Section 11 sets the mechanism for factors that refer to another injury or disease covered by another SoP: if a factor refers to such an injury or disease, that other Statement of Principles applies according to its terms.

In short, the main concepts are definitional precision, a closed list of alternative causative factors, temporal and service‑relationship constraints, and an embedded cross‑reference mechanism to other SoPs for overlapping conditions. The Schedule supplies granular clinical and measurement rules that will materially affect evidence production and adjudication.

This Statement of Principles applies directly to claimants and decision‑makers operating under two statutory claim gateways: claims to which section 120A of the Veterans' Entitlements Act 1986 applies, and claims to which section 338 of the Military Rehabilitation and Compensation Act 2004 applies (s 5). Those provisions are not reproduced in the instrument, but the instrument’s operation is explicitly limited to these claim types; therefore serving or former members of the Australian Defence Force and specified veterans who pursue entitlements under the VEA or MRCA are the primary affected persons.

In practice the SoP influences at least the following actors:

• Claimants, including veterans, members of Peacekeeping Forces and members of the Forces covered by the MRCA and VEA definitions of relevant service (Schedule 1 , definition of relevant service). The instrument’s criteria govern the medical‑evidentiary threshold for establishing a reasonable hypothesis that acute pancreatitis is related to relevant service (s 9, s 10). Claimants seeking benefits tied to service connection will need to address these factors in their medical evidence.

• Medical practitioners and specialist clinicians who produce opinions and objective evidence about the condition. The SoP specifies the kinds of clinical and laboratory findings and timing relationships that are dispositive for reasonable‑hypothesis purposes. For example, documentation of triglyceride levels above 11.3 mmol/L, records of dialysis, operative reports, serology for specified infections, or a clear drug start/stop relationship consistent with s 9(13) will be material to claims.

• Decision‑makers in the Department of Veterans’ Affairs and persons applying the VEA and MRCA statutory frameworks. The instrument is made under s 196B(2) of the VEA (s 3) and thus supplies a determinative medical standard that those decision‑makers must apply when assessing whether a reasonable hypothesis is raised. Section 11 also requires them to apply other SoPs where factors reference other covered conditions.

• Legal advisers, advocates, and tribunals involved in appeals and reviews. Although this instrument does not itself set out appeal pathways, it materially frames the evidence that adjudicators will assess; legal counsel and advocates will need to marshal evidence in the form required by the SoP to rebut or satisfy its factors. The instrument does not itself name courts or cases.

• Third parties who hold medical, pharmacy, hospital, surgical or forensic records. The SoP’s many time‑bound factors (for example, trauma within seven days, procedures within 30 days, drug‑related onset within two months and dechallenge) make contemporaneous records and precise dates materially important.

The Schedule further affects the population by defining thresholds that alter who meets the criteria: for example "being obese" is BMI 30 or greater (Schedule 1), and pack‑years are precisely quantified. The instrument therefore directly affects evidentiary strategies, record‑keeping emphasis, and the clinical content of medico‑legal reports for the groups above.

The instrument itself establishes medical standards rather than prescribing administrative duties or conferring substantive benefits. Nevertheless, it creates practical rights and duties in the claim assessment process by determining which medical facts (if established and service related) will raise a reasonable hypothesis connecting acute pancreatitis to relevant service.

Duties on decision‑makers and administrators

• The Repatriation Medical Authority made the Statement under subsection 196B(2) of the VEA (s 3). While the instrument does not restate the statutory decision‑making framework, its status as a SoP means that decision‑makers applying the VEA and MRCA thresholds must treat the factors in s 9 as the Authority’s determination of medical causation thresholds for reasonable hypothesis purposes. The instrument requires that if a factor in s 9 exists and is related to relevant service, that fact is sufficient to raise a reasonable hypothesis (s 9; s 10). The interaction with other SoPs is also mandated: where a factor in s 9 refers to an injury or disease subject to another SoP, the other SoP's factors apply according to its terms (s 11).

Rights and practical entitlements for claimants

• Claimants have the practical right to have decision‑makers consider whether any of the s 9 factors are present and related to their relevant service. The SoP gives claimants a roadmap of the specific clinical, laboratory and exposure evidence that will be decisive for raising a reasonable hypothesis. For example, showing triglyceride levels above 11.3 mmol/L at clinical onset (s 9(15)) or imaging/hospital records demonstrating cholelithiasis at the time of onset (s 9(3)) are concrete evidentiary pathways.

Obligations on medical reporters and treating clinicians

• The SoP places an implicit duty on clinicians preparing medico‑legal reports to address the presence or absence of each potentially relevant factor and to provide the specific forms of evidence the SoP contemplates: dates of procedures, operative records, drug start dates and discontinuation with resulting symptom course (s 9(12)-(13)), serological or clinical evidence for listed organisms (Schedule 1), BMI calculation (Schedule 1), and quantified alcohol and smoking histories (s 9(1)-(2) and Schedule 1 definitions). The instrument’s detailed definitions mean that vague or non‑quantified statements will not match the SoP’s terms.

Limits and qualifications

• Section 10(1) imposes the requirement that any s 9 factor must be related to relevant service. Thus the presence of a factor in isolation does not remove the need to demonstrate a service link. Section 10(2) limits the application of factor 9(26) (inability to obtain appropriate clinical management) to situations where the acute pancreatitis pre‑existed or occurred during service but did not arise out of it. Rights to have a factor applied therefore depend on both the factor’s existence and the service nexus.

Administrative interplay rights

• Where s 9 references another injury or disease that is itself covered by a different SoP, s 11 gives the claimant the right to have the other SoP applied in accordance with its terms as in force from time to time, which can change the evidentiary detail for that linked factor.

The instrument does not itself create new benefit entitlements, penalties or appeal mechanisms. It functions as a medical standard that creates duties on decision‑makers to apply specified factors when considering whether a reasonable hypothesis exists, and it creates practical evidentiary rights for claimants to adduce the specific kinds of proof listed.

The Statement of Principles is not a penal instrument; it contains no sanctions, fines, criminal provisions or administrative penalties. The instrument sets medical evidentiary standards to be used in adjudicating claims under the VEA and MRCA. Enforcement in this context is the application of the SoP by decision‑makers when deciding claims, and any administrative or judicial review processes available under the VEA and MRCA frameworks rather than under the Statement itself.

What the instrument does specify about enforcement mechanisms is implicit and administrative:

• Authority and status. The instrument is made under s 196B(2) of the VEA (s 3), which is the statutory power under which the Repatriation Medical Authority issues Statements of Principles for use in claims. The practical effect is that decision‑makers under the VEA and MRCA will rely upon the SoP as the Authority's medical determination for the reasonable‑hypothesis standard.

• Application to claims. The instrument expressly applies to claims to which s 120A of the VEA or s 338 of the MRCA applies (s 5). Those sections of the VEA and MRCA contain the statutory machinery for claim determination and review; the SoP functions within that machinery as the medical standard. The instrument does not specify the decision process, timeframes, or review rights; those are governed by the parent Acts.

• Repeal of prior SoP. The instrument repeals the earlier 2011 SoP for acute pancreatitis (s 4). Practically this means that, from the commencement date (s 2), decision‑makers should apply this instrument and not the 2011 instrument when assessing whether a reasonable hypothesis is raised. The instrument does not specify transitional arrangements or retrospective application; the commencement date and repeal are the only timing provisions contained within it.

• No express enforcement bodies or penalties. There is no provision in the SoP imposing duties on third parties enforceable by penalty. It does not create obligations to collect or produce information, nor does it authorise compelled disclosure beyond the normal powers available under the VEA and MRCA regimes.

Consequently, enforcement is administrative and evidentiary rather than punitive. The SoP is enforced by being the medical yardstick used by decision‑makers in adjudicating claims, and by how tribunals or review bodies consider the SoP‑based arguments within the VEA/MRCA appeal frameworks. The instrument itself does not set out those appeal routes or remedies.

The Statement of Principles is an instrument made under subsection 196B(2) of the Veterans' Entitlements Act 1986 (s 3) and is designed to operate inside the VEA and MRCA claim processes. The instrument identifies multiple statutory and non‑statutory references and contains explicit cross‑references to other Statements of Principles and classification systems. Key interactions are as follows.

Interaction with VEA and MRCA

• Scope. The SoP expressly applies only to claims to which s 120A of the VEA or s 338 of the MRCA applies (s 5). The instrument therefore supplements and is subordinate to the procedural and substantive provisions of those Acts. The SoP does not replace VEA or MRCA decision rules; it supplies the medical causation standard for reasonable hypothesis assessments under them.

• Authority. The Repatriation Medical Authority’s power to make SoPs arises from the VEA (s 3). The SoP’s application in adjudication will be within that statutory hierarchy.

Interaction with other Statements of Principles

• Section 11 establishes a directing rule: if a s 9 factor refers to an injury or disease that is the subject of another SoP made under s 196B(2), then the factors in that other SoP apply in accordance with the terms of that other SoP as in force from time to time. This creates a hierarchical or referential interaction between SoPs, meaning decision‑makers must consult and apply the current SoP(s) relevant to the cross‑referenced disease or injury.

Interaction with ICD‑10‑AM and clinical standards

• The instrument references the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD‑10‑AM), Tenth Edition, effective date 1 July 2017, as the source for the K85 code (s 7(3)-(4)). It nonetheless makes clear that the statutory definition in s 7(2) controls application. This dual reference ties administrative coding practice to the SoP but does not make the ICD code determinative.

• The instrument also references the Australian standard for alcohol calculation: it instructs that alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink (s 9(2) note). This links the SoP to an external clinical/public health metric.

Interaction with medical/clinical practice and records law

• The SoP requires clinical and laboratory measurements (for example triglycerides, BMI, serology), operative and procedure dates, dialysis records, transplant history, and documented drug therapy start and stop dates. Those evidentiary requirements implicate medical records retention, clinical reporting practices, pharmacy records and data privacy regimes, but the instrument itself does not alter any legal obligations concerning record keeping or disclosure beyond their ordinary operation.

No explicit interaction with other statutory regimes

• The instrument does not purport to modify entitlements under other compensation, workers’ compensation or social security schemes. It limits itself to the VEA/MRCA claims it references. No other Acts, tribunals or criminal provisions are invoked in the instrument text.

Practical effect

• Decision‑makers must apply this SoP alongside relevant provisions of the VEA and MRCA. Where a factor in s 9 refers to another injury or disease covered by its own SoP, the other SoP’s criteria are to be applied as in force (s 11). Medical record coders and clinicians should note the ICD‑10‑AM cross‑reference for coding purposes (s 7(3)-(4)), but claims assessment will rest on the SoP’s clinical definition and Schedule definitions.

This instrument contains limited express amendment history within its text. The key chronological points set out in the instrument itself are:

• The instrument is identified as Statement of Principles concerning acute pancreatitis (Reasonable Hypothesis) (No. 5 of 2020). The cover indicates it was determined by the Repatriation Medical Authority and dated 28 February 2020 (cover and header information).

• Commencement. The instrument commences on 23 March 2020 (s 2). That is the operative date from which the instrument applies.

• Repeal of prior instrument. Section 4 expressly repeals the Statement of Principles concerning acute pancreatitis No. 85 of 2011 (Federal Register of Legislation No. F2011L01442) made under subsection 196B(2) of the VEA. The text provides the federal register number for the repealed instrument, establishing a clear replacement relationship between the 2011 instrument and this 2020 instrument.

No further amendments, variations, or transitional provisions are recorded within this instrument. The instrument does not include retrospective coverage clauses, grandfathering provisions, or savings clauses. It also does not include an express note about how claims that straddle the repeal or commencement dates are to be treated; the only timing instructions are the commencement date (s 2) and the repeal (s 4).

Because the instrument instructs that other SoPs apply "as in force from time to time" where cross‑references arise (s 11), the practitioner must be alert to any subsequent amendments to other SoPs that could affect how factors in this SoP are treated. Those subsequent amendments, if any, would not be reflected in this particular instrument and would need to be checked in the relevant SoP texts.

The Schedule of definitions is part of the instrument as made and contains detailed specified lists (drugs, procedures, organisms, infestations, agents, diseases). Any amendment to those lists would materially change how particular factors in s 9 operate. The instrument itself does not provide a history of prior amendments except for the single repeal. Users should therefore consult the Federal Register of Legislation or the Repatriation Medical Authority for any later amendments or subsequent replacement instruments after 2020.

The text of the Statement of Principles contains no reference to any litigation, judicial decisions, or tribunal determinations interpreting this instrument. It does not list cases, judgments, or precedents. Consequently, there is no litigation history recorded within the instrument itself.

What the instrument does make clear is that it is a medical determinative instrument made under subsection 196B(2) of the VEA (s 3) and applied to claims under s 120A of the VEA or s 338 of the MRCA (s 5). Litigation or review that might engage this instrument would therefore occur in the context of dispute mechanisms provided by the VEA or the MRCA , for example administrative review, tribunal proceedings or judicial review of decisions made under those Acts , but the instrument does not set out those routes and does not cite any authorities on how tribunals or courts have treated SoPs.

Because the instrument is a medical‑evidentiary standard, challenges in litigation would likely focus on whether the relevant factor in s 9 is present and related to relevant service for a particular claimant, or on how decision‑makers have applied the SoP and its Schedule definitions in an individual case. The instrument itself prescribes specific factual questions (for example, timing windows, laboratory thresholds, dechallenge evidence for drugs) that are likely to be the subject of evidentiary dispute in any review bodies, but the instrument does not supply case law.

Practitioners seeking authority on interpretation of SoPs, or the application of the reasonable hypothesis standard in the VEA/MRCA context, must therefore look to decisions under those Acts and to any tribunal or court authority that has considered the use of Repatriation Medical Authority Statements of Principles more generally. Such authorities are external to this instrument and are not cited within it; the instrument does not itself record or purport to be authoritative jurisprudence.

The instrument contains a number of technical, timing and definitional traps that materially affect how evidence should be prepared and how decision‑makers will apply the Statement. These are concrete points that commonly cause errors in claims if not anticipated.

1. Reasonable hypothesis is factor‑by‑factor, but service link is required

• The presence of any one factor in s 9 is sufficient as a minimum to raise a reasonable hypothesis, but s 10(1) requires that the factor be related to relevant service. Do not assume that establishing a factor automatically connects it to service; a separate service nexus must be shown.

2. Time windows are tight and differ by factor

• Several factors have narrow temporal windows. Examples: penetrating or major blunt trauma to the upper abdomen or back must be within seven days of clinical onset (s 9(6)); spinal cord injury within seven days (s 9(7)); endoscopic retrograde cholangio‑pancreatography or sphincter procedures within seven days (s 9(9)); specified surgeries within 30 days (s 9(8)); drug‑related onset has a two month onset window plus required dechallenge evidence (s 9(13)). Failure to document exact dates will often be decisive.

3. Pack‑years and alcohol quantification are precisely defined

• Smoking must be at least 15 pack‑years before clinical onset and cessation carries a ten‑year limit for relevance (s 9(1) and Schedule 1). The Schedule contains a specific formula equating pack‑years to number of cigarettes and weight of tobacco; casual or qualitative smoking histories may be insufficient. Alcohol consumption must be an average of at least 420 grams per week for at least ten years prior to onset (s 9(2)), and the instrument instructs use of the Australian standard of ten grams per standard drink. Practical consequence: experts must translate histories into these specific metrics.

4. Dechallenge requirement for drug causation

• Factor 9(13) requires four elements: onset within two months of starting the drug, cessation of symptoms following discontinuation, absence of pancreatitis evidence prior to starting the drug, and where treatment continued, treatment must have been ongoing for at least three days before clinical onset. All four must be met. Mere association with a drug class in the Schedule is insufficient unless these criteria are satisfied.

5. Cross‑references to other SoPs

• Section 11 requires application of other SoPs where a s 9 factor refers to another injury or disease covered by a different SoP. Practitioners must check the current status and terms of those other SoPs. Failure to do so can lead to misapplication of criteria.

6. Factor 9(26) limits and scope

• Factor 9(26) (inability to obtain appropriate clinical management) does not operate generally. Section 10(2) limits it to material contribution to or aggravation of acute pancreatitis where the pancreatitis was suffered or contracted before or during but did not arise out of relevant service. This means that inability to access care will not be used to establish primary causation for conditions that arose out of service, and only applies in the narrower aggravation/product contributory context.

7. ICD‑10‑AM code is not determinative

• The instrument notes that although acute pancreatitis attracts ICD‑10‑AM K85, the meaning for application is the statutory definition at s 7(2) (s 7(3)-(4)). Coding alone without clinical confirmation may be insufficient.

8. Laboratory thresholds and diagnostic specificity

• Some factors require objective laboratory thresholds (for example triglyceride levels above 11.3 mmol/L at clinical onset, s 9(15)). Others require serological or clinical evidence for specified organisms (Schedule 1). Accurate, contemporaneous lab values are therefore essential.

9. Obesity limited to severe acute pancreatitis

• Obesity as a factor applies only for severe acute pancreatitis (s 9(25); Schedule 1 defines severe acute pancreatitis as requiring hospitalisation, or death). Obesity is not a standalone factor for milder presentations.

10. Repeal and commencement dates create administrative issues

• The instrument repeals the 2011 SoP and commences on 23 March 2020 (s 2-4). The instrument contains no transitional provisions; practitioners should verify which instrument applied to incidents or claims that preceded commencement where that timing is material.

11. Broad specified lists can dilute specificity

• The Schedule contains long specified lists (drugs, procedures, infections) that may invite contested expert opinions about whether an individual drug or organism is the proximate cause. For example the drug list includes many classes from ACE inhibitors to propofol and chemotherapy agents. Inclusion in the list does not by itself satisfy the drug causation criterion 9(13); the temporal and dechallenge tests remain decisive.

12. Terminal event definition affects fatal cases

• Death from acute pancreatitis is defined to include death from a terminal event or condition contributed to by the acute pancreatitis (s 7(5)). The Schedule defines terminal event in terms such as respiratory failure and cardiac arrest. Practitioners must demonstrate contribution to the terminal event, not only the presence of a terminal event.

Being attentive to these precise temporal, definitional and evidentiary points will materially affect whether a claim succeeds in raising a reasonable hypothesis.

Complying with this Statement of Principles requires aligning claim evidence and medico‑legal reports to the instrument’s precise factors, timing windows and Schedule definitions. Below is a practical compliance checklist mapped to the SoP’s provisions.

1. Establish which claims the SoP applies to

• Confirm that the claim is one to which s 120A of the VEA or s 338 of the MRCA applies (s 5). If not, this SoP will not be binding for the claim.

2. Confirm diagnosis against the statutory definition

• Ensure the clinical diagnosis matches s 7(2): an acute inflammatory condition due to autodigestion of pancreatic tissue by its own enzymes. Use contemporaneous clinical notes, imaging, enzyme levels and discharge summaries. Do not rely on an ICD code alone; s 7(3)-(4) emphasises that the definition in s 7(2) governs application.

3. Map the relevant s 9 factors and gather targeted evidence

• For each factor potentially present, collect the documentary evidence the SoP requires:
  • Smoking (s 9(1) and Schedule 1): provide a quantified smoking history converted to pack‑years per the Schedule formula. If smoking ceased, confirm the date of cessation to assess the ten‑year cut‑off.
  • Alcohol (s 9(2)): document average weekly consumption in standard drinks, convert to grams per week using the Australian standard of ten grams per standard drink, and show the ten‑year duration if applicable.
  • Cholelithiasis, biliary microlithiasis/sludge (s 9(3)-(4), Schedule 1): provide imaging reports (ultrasound, CT), operative findings, or endoscopy reports demonstrating presence at clinical onset.
  • Pancreatic outflow obstruction (s 9(5), Schedule 1): provide imaging or endoscopic evidence of duct obstruction and the specific causal disorder (tumour, choledochocele, foreign body).
  • Trauma and spinal cord injury (s 9(6)-(7)): provide emergency department, imaging, surgical or inpatient records with exact dates within the seven‑day window.
  • Procedures (s 9(8)-(9), Schedule 1): produce operative and endoscopic procedure notes, with dates within 30 or seven days as required.
  • Dialysis and transplant (s 9(10)-(11)): provide procedure logs, dialysis start dates, transplant records and immunosuppression regimens.
  • Drug therapies (s 9(12)-(13), Schedule 1): document drug names, start and stop dates, dosing regimens, and the temporal relationship to symptom onset. For s 9(13) ensure the report addresses onset within two months, symptom cessation after discontinuation, absence of prior evidence, and at least three days’ exposure if continued until onset.
  • Diabetes, hypertriglyceridaemia, hypercalcaemia (s 9(14)-(16)): include contemporaneous blood glucose/HbA1c, lipid panels (document triglyceride >11.3 mmol/L), serum calcium and relevant endocrinology consults.
  • Specified diseases, infections, infestations (s 9(17), (19)-(21) and Schedule 1): attach serology, culture results, specialist reports and explain clinical evidence per Schedule definitions.
  • Envenomation and toxic ingestion (s 9(22)-(24) and Schedule 1): provide toxicology reports, emergency department records, and details showing occurrence within seven days.
  • Obesity and severity (s 9(25) and Schedule 1): supply measured height and weight, calculate BMI using the Schedule formula (BMI = W/H2), and confirm hospitalisation or death where obesity is relied on.
  • Inability to obtain appropriate clinical management (s 9(26) and s 10(2)): document the prior existence of acute pancreatitis and show how lack of care materially contributed to aggravation; note the limitation that this factor applies only where the pancreatitis was suffered or contracted before or during but did not arise out of service.

4. Tie each relevant factor to relevant service

• Prepare an evidentiary statement or expert opinion that links the identified factor to the claimant’s relevant service, addressing the service relationship requirement in s 10(1). This may include service medical records, deployment histories, exposure reports, or testimony about treatment access during service.

5. Address cross‑referenced SoPs

• If any s 9 factor refers to another disease or injury covered by a different SoP, obtain and apply that other SoP’s criteria as required by s 11. Check the current versions of those other SoPs to ensure compliance with their factors and definitions.

6. Produce structured medico‑legal opinions

• Ask medical experts to structure opinions explicitly against the SoP factors, stating whether each element of a factor is present and whether it is related to relevant service. For drug causation, experts should address each element in s 9(13) (timing, dechallenge, absence beforehand, duration where relevant).

7. Ensure contemporaneous lab and imaging records are preserved

• Because the SoP relies on specific lab thresholds and imaging diagnoses at the time of clinical onset (for example triglyceride cut‑off in s 9(15), presence of biliary sludge in s 9(4)), preserve and contemporaneously obtain those records. Where lab values were taken after treatment commenced, experts should be asked to explain their probative value in light of the SoP’s requirements.

8. Be precise with dates and measurements

• The SoP contains many numerical thresholds and narrow time windows. Ensure that all dates, measurements, drink conversions, cigarette counts and BMI calculations are explicitly set out in evidence rather than inferred.

9. Check for the applicable SoP version

• The instrument repealed the 2011 SoP and commenced on 23 March 2020 (s 2-4). Confirm which SoP was in force for the date(s) relevant to the claim, and whether any later SoPs or amendments to linked SoPs have been made since this instrument. Section 11’s "as in force from time to time" language requires up‑to‑date checking.

10. Prepare to rebut non‑applicability arguments

• Decision‑makers may argue that the factor, even if present, is not service related. Prepare contemporaneous evidence of exposures or service events, and expert causation opinions that address the mechanistic link between the factor and the claimant’s service.

Following this checklist will align claim preparation with the instrument’s textual requirements and reduce avoidable evidentiary deficiencies.