Statement of Principles concerning alcohol use disorder (Balance of Probabilities) (No. 86 of 2025)

The instrument’s analysis and decision-making hinge on a small set of core concepts defined in the text. These concepts both narrow and structure the evidentiary pathways available to claimants, and they are the nodes through which adjudicators will link service to clinical states.

1. Alcohol use disorder as a DSM-5-TR derived diagnosis. The instrument adopts the DSM-5-TR criteria, operationally requiring a problematic pattern of alcohol use with at least two of ten listed symptoms within a 12-month period, and specifying tolerance and withdrawal manifestations (s7(2)). It expressly excludes solely alcohol-induced disorders where the DSM-style alcohol use disorder is not present.

2. Clinical onset and clinical worsening. Many of the listed factors are time-limited with reference to "clinical onset or clinical worsening". Section 10 clarifies that the "clinical worsening" limb applies only where the alcohol use disorder was suffered or contracted before or during (but did not arise out of) relevant service, and that the factors must be related to relevant service. Thus the instrument addresses both new-onset and aggravation scenarios.

3. Relevant service. The instrument applies only where the person rendered "relevant service", which is defined in Schedule 1 to include eligible war service and defence service under the VEA (excluding certain service types) and peacetime service under the MRCA (Schedule 1 definition of relevant service). The connection required is that at least one factor in s9 "must be related to the relevant service rendered by the person" (s10(1)).

4. Prescribed qualifying factors and temporal windows. Section 9 enumerates the factors. The instrument uses temporal cut-offs tied to the date of clinical onset or clinical worsening: category 1A and 1B stressors within 2 years; category 2 stressors within 6 months; death of a close person within 10 years; Roux-en-Y within 3 years; intimate partner violence within 2 years; smoking pack-year requirement combined with a 3-month post-cessation window; concussion or moderate to severe TBI within 3 years; and inability to obtain appropriate clinical management before worsening (s9, Schedule 1). The Schedule also supplies detailed definitions of stressor categories and other terms.

5. Cross-reference to other Statements of Principles. Section 11 requires that if a factor in s9 refers to an injury or disease for which there is a separate Statement of Principles under s196B(3) VEA, then the factors in that other Statement apply in accordance with that Statement. This creates an interlocking regime: some pathologies may be proved via other Statements rather than directly under this instrument.

6. Death inclusion. The instrument treats death from a terminal event as within scope if the terminal event was contributed to by the person’s alcohol use disorder. The Schedule defines "terminal event" with examples such as pneumonia, respiratory failure and cardiac arrest (s7(6), Schedule 1).

7. Clinically significant disorder of mental health. The instrument treats the presence of a clinically significant mental disorder as a standalone qualifying factor at clinical onset/worsening (s9(1)). The Schedule defines this threshold as a disorder of sufficient severity to warrant ongoing management, and importantly clarifies that the absence of prior management does not prevent the condition being "clinically significant" for the instrument’s purposes.

8. Measurement concepts. The instrument uses measurement constructs such as "one pack-year" (Schedule 1) and ties DSM-5-TR/ICD-10-AM codes to diagnostic mapping while insisting the operative definition for the instrument is the DSM-5-TR derived one (s7(3)-(4)).

Together these concepts create an evidentiary scaffold: to establish service connection claimants must show the DSM-5-TR alcohol use disorder, the temporal relation between a specified qualifying factor and clinical onset/worsening, and that one or more of those factors is related to the claimant’s relevant service. The instrument places considerable emphasis on timing and the link-back to service, and it imports other Statements of Principles where overlapping injuries or diseases are implicated.

The primary legal subjects affected by this Statement of Principles are claimants who seek a determination that alcohol use disorder or death from alcohol use disorder is connected with their "relevant service" under the VEA or MRCA. The instrument explicitly applies to claims to which section 120B of the VEA or section 339 of the MRCA applies (s5). Relevant service is defined in Schedule 1 to include eligible war service and defence service under the VEA (other than certain specified types) and peacetime service under the MRCA (Schedule 1).

Who pays: Scheme liability under the VEA/MRCA will be engaged only where the claim satisfies the instrument’s requirements. The instrument itself does not set or pay benefits, but it is an evidentiary instrument used by decision makers in determining entitlement under the VEA/MRCA. Funding and payment consequences are therefore realised through the underlying statutes and administrative processes that act on this Statement.

Who decides: The Repatriation Medical Authority determines and issues this Statement under s196B(3) of the VEA (s3). Operational decisions on individual claims will be made by decision-making officers within the Department or Tribunal bodies charged with applying the VEA/MRCA, using this instrument as the medical-scientific statement that identifies connection factors. The instrument also requires that where a factor points to another Statement of Principles, the terms of that other Statement apply (s11).

Secondary affected parties:

• Treating clinicians and medico-legal experts. They must apply the DSM-5-TR derived diagnostic criteria and address the timing and relationship-to-service questions. The instrument’s diagnostic and timing requirements will shape clinical reports and evidence.

• Veterans’ advocates, lawyers and claims agents. The factors and their temporal ceilings become the parameters for assembling documentary evidence, witness testimony and medical opinion. For example, evidence of a category 1A or 1B stressor will be relevant only if it occurred within two years of clinical onset/worsening (s9).

• Adjudicators and case officers. They will interpret "related to the relevant service" and "inability to obtain appropriate clinical management", and will apply Schedule 1 definitions when determining whether a factor exists and is related to service.

• Veterans and family members in bereavement cases. The instrument includes death from alcohol use disorder where a terminal event was contributed to by the disorder (s7(6)). Bereavement as a factor is captured as the death of a person with a close family bond or close personal relationship within 10 years before onset or worsening (s9(4)).

• Other claimants whose conditions are already covered by separate Statements. Section 11 gives primacy to the terms of other Statements of Principles where a factor points to an injury or disease that is subject to another Statement.

Indirect effects: The instrument will influence the type and timing of clinical intervention and record-keeping by health services that treat veterans. For example, surgical records (Roux-en-Y within 3 years), documented smoking histories, concussion and TBI records, and documentation of access to clinical management will all have heightened evidentiary importance because they are enumerated factors (s9, Schedule 1).

Excluded groups: The instrument does not apply to persons whose claims fall outside the referenced VEA/MRCA claim provisions, nor does it apply to purely alcohol-induced disorders that do not meet the DSM-5-TR alcohol use disorder definition (s7(2) note).

This instrument is a Statement of Principles. It sets out factors used to determine, on the balance of probabilities, whether alcohol use disorder or death from it is connected with a person’s relevant service. It does not, on its face, create statutory duties, obligations, criminal offences or private rights of action. Nevertheless the instrument allocates legal effects via its role in adjudication under the VEA and MRCA. The following are the operative duties, rights and decision nodes that arise from, or are shaped by, the instrument.

Duties and roles created or affected:

• Decision makers’ duty to apply the Statement. Where claimants make claims to which s120B VEA or s339 MRCA apply, decision makers must treat this Statement as the Repatriation Medical Authority’s view of the medical‑scientific evidence relevant to connecting alcohol use disorder to service (s3, s8). The instrument does not itself prescribe procedural steps, but it is the medical foundation that adjudicators will use in applying statutory decision-making provisions under the VEA/MRCA.

• Evidence-related duties on claimants. To satisfy the statutory balance of probabilities test, claimants must adduce evidence that establishes (a) the DSM-5-TR alcohol use disorder or death from it (s7(2), s7(6)), (b) the existence of at least one qualifying factor in s9, and (c) that the factor was related to the person’s relevant service (s9, s10).

• Expert duties. Medical experts preparing reports must demonstrate how the DSM-5-TR criteria are met, date clinical onset or clinical worsening, and explain the causal link between the qualifying factor(s) and service. The instrument’s explicit timing windows (for example 2 years, 6 months, 10 years etc.) impose an evidentiary obligation to establish temporality.

Rights and legal effects:

• Right to have the Statement applied to a claim. Claimants whose claims fall within the identified VEA/MRCA provisions are entitled to have decision makers consider this Statement when determining service connection. The instrument binds as the RMA’s medical-scientific statement; it will figure in reasons for decision.

• Right to rely on cross-referenced Statements. Section 11 confirms that where a s9 factor refers to an injury or disease covered by another Statement of Principles under s196B(3) VEA, the claimant may invoke that other Statement in accordance with its terms. This operationally allows claimants to proceed under the Statement most apt for the referred injury/disease.

• Evidentiary presumptions are not automatic. The instrument does not create statutory irrebuttable presumptions. It sets out the factors that, if present and related to relevant service, satisfy the balance of probabilities test. Adjudicators still must be satisfied on the balance of probabilities that the condition is connected to service, using this instrument as the operative medical-scientific guide (s8, s9, s10).

Notable interpretive duties and uncertainties:

• Duty to interpret "related to the relevant service". Section 10(1) requires that any s9 factor be related to the person’s relevant service. The instrument does not define the precise legal threshold of "related to", leaving application to decision-makers and evidence adduced by claimants.

• Clinical worsening vs onset. Section 10(2) confines the clinical worsening limb to cases where alcohol use disorder pre-existed service or was suffered/contracted before or during service but did not arise out of it. This places a duty on decision-makers to determine the chronological relationship between disorder and service with precision.

• Application of Schedule definitions. The Schedule provides detailed definitions (for example stressor categories, clinically significant disorder, pack-years). Decision-makers must apply these definitions when establishing whether a particular fact satisfies a s9 factor.

Taken together, the instrument sets out rights to have medical evidence assessed against a defined list of factors and corresponding duties on claimants and experts to produce evidence that maps to those factors and the temporal and relational requirements the instrument imposes. The instrument does not itself create new enforcement mechanisms, statutory duties on third parties, or explicit administrative procedures; it is a medical-evidentiary statement that affects how existing statutory claim processes are decided.

This Statement of Principles contains no express criminal offences, pecuniary penalties, or administrative sanctions. It is an evidentiary instrument: its legal force is that decision-makers apply it when determining entitlement under the VEA and MRCA. The instrument therefore enforces its norms indirectly through the adjudicative consequences that attach under the underlying statutes where a medical connection is established or rejected.

Key enforcement and penalty-related observations grounded in the instrument:

• No direct penalties in the instrument. The text contains no provisions creating offences, financial penalties, or compliance sanctions. Repeal, commencement, application and definitional matters are administrative in character (s2-s5). Accordingly, any "enforcement" occurs through application in statutory claim processes rather than by sanctioned non-compliance with the instrument itself.

• Adjudicative consequences flow from findings of connection. The instrument is intended to be applied in determining whether a person’s alcohol use disorder or death from it is "connected with the circumstances of a person's relevant service" on the balance of probabilities (s8, s9, s10). The legal consequence of a positive finding (for example, entitlement to particular benefits) is governed by the VEA or MRCA provisions referenced at s5, not by this Statement.

• Potential administrative remedies are external to the instrument. Remedies for adverse decisions, such as internal review, merits review or judicial review, are provided by the VEA/MRCA and their associated administrative processes. The instrument itself does not set out review avenues. Where a decision-maker misapplies or ignores this Statement, a claimant would rely on the statutory review mechanisms in the VEA/MRCA or judicial review avenues recognised under general administrative law. Those mechanisms are not described or created in the Statement.

• Enforcement of standards in medical evidence. While there are no criminal or administrative penalties in the Statement, the instrument imposes evidential standards for establishing connection: the DSM-5-TR diagnosis, temporal windows for factors, relation to relevant service, and cross-reference requirements to other Statements (s7(2), s9, s10, s11). The practical "sanction" for failing to meet those standards is an unfavourable decision on entitlement.

• Interaction with other Statements and their enforcement mechanisms. Section 11 binds the claimant and decision-maker to apply the terms of any other Statement referenced by a s9 factor. Enforcement of those other Statements’ terms likewise occurs through VEA/MRCA claim processing.

Implementation risks relevant to enforcement:

• Interpretive discretion and evidentiary disputes. Terms such as "related to the relevant service", "inability to obtain appropriate clinical management", and "clinically significant disorder of mental health" require evaluative judgments. The absence of statutory penalty provisions means dispute resolution relies on administrative decision-makers and review bodies, which may produce variability in outcomes.

• No statutory timelines or procedural steps in the instrument. The instrument imposes evidentiary criteria but not procedural enforcement mechanisms (for example no time limits for lodging claims in relation to the Statement). Those procedural aspects remain governed by the VEA/MRCA.

In short, the instrument enforces norms by structuring adjudicative findings rather than by imposing standalone penalties. Its "enforcement effect" is realised when adjudicators apply its factors and definitions to conclude for or against a causal connection between alcohol use disorder and relevant service, and the statutory consequences then follow under the VEA or MRCA.

The Statement sits within a network of statutory and medical-classification instruments, and it explicitly cross-references other legal and clinical instruments.

Primary statutory interaction

• Veterans’ Entitlements Act 1986. The Statement is made under subsection 196B(3) of the VEA (s3). Its legal role is to provide the Repatriation Medical Authority’s medical-scientific view for adjudication under the VEA. The instrument also repeals the earlier Statement made under the same subsection (s4). The Statement applies to claims to which section 120B of the VEA applies (s5). Because the Statement does not itself specify entitlement rules, the VEA provisions continue to determine substantive rights, procedural steps and remedies.

• Military Rehabilitation and Compensation Act 2004. The instrument applies to claims to which section 339 of the MRCA applies (s5). Where MRCA claim provisions govern process or entitlements, decision-makers must apply this Statement’s factors when assessing medical connection.

Interplay with other Statements of Principles

• Section 11 requires that if a s9 factor refers to an injury or disease that is the subject of another Statement of Principles under s196B(3) VEA, then the factors in that other Statement apply according to its terms. This creates an integrated framework where determinations concerning overlapping conditions must follow the most specific, contemporaneous Statement. Practically, where a s9 factor invokes another Statement (for example, a traumatic brain injury), decision-makers must consult and apply that other Statement’s factors and definitions.

Interaction with medical classification systems

• DSM-5-TR. The instrument explicitly derives its alcohol use disorder diagnostic criteria from DSM-5-TR (s7(2)) and defines DSM-5-TR in Schedule 1. Use of DSM-5-TR, rather than relying solely on ICD codes, shapes diagnostic practice and medico-legal reporting.

• ICD-10-AM. The instrument notes that while alcohol use disorder attracts ICD-10-AM codes F10.1 and F10.2, the meaning for this Statement is the DSM-5-TR derived one (s7(3)-(4)). It also identifies the specific edition and publication details for the ICD-10-AM used as a reference (s7(4)). This dual citation means medical records coded under ICD-10-AM may need interpretation against DSM-5-TR criteria when used as evidence in claims.

Other legislative and policy interfaces

• There is an implicit operational interface with the administrative procedures, evidence rules and review mechanisms in the VEA and MRCA. The Statement does not amend those statutes’ procedural or remedial frameworks; it is an evidentiary input into them.

• Health, privacy and evidence-law regimes will be relevant in practice. The Statement’s reliance on clinical records, surgical records, smoking histories and psychiatric diagnoses means that medical records, privacy legislation and the rules governing expert reports will intersect when claimants marshal evidence. The Statement itself does not address privacy or evidence admissibility.

Potential friction points and interpretive overlaps

• Temporal and causal linkage. The requirement that a s9 factor be "related to the relevant service" (s10(1)) interacts with statutory causal standards in the VEA/MRCA. Because the instrument defines medical-scientific probability (s8) but does not prescribe the legal test for causation beyond the balance of probabilities framework, decision-makers must reconcile this Statement’s medical criteria with statutory causation jurisprudence under the VEA/MRCA.

• Cross-referenced Statements. Where other Statements address overlapping injuries (for example TBI, PTSD or other mental health disorders), the practical application will require navigating potentially differing temporal windows, definitions and thresholds. Section 11 directs adherence to the other Statement’s terms, but it does not harmonise inconsistencies; administrative application will therefore rely on interpretive work by decision-makers.

• Classification mismatch. The choice to define alcohol use disorder by DSM-5-TR while recording ICD-10-AM codes introduces a need for clinical translation. Medical witnesses and decision-makers will need to be explicit in mapping ICD coding in clinical records to DSM-5-TR criteria required by this Statement.

In sum, the Statement functions as a medical-evidentiary instrument that interacts primarily with the VEA and MRCA statutory frameworks, other Statements of Principles, and medical classification systems. Its real-world effect depends on the administrative application of its definitions and temporal rules together with the pre-existing procedural and remedial architecture of the underlying statutes.

This Statement of Principles is identified as No. 86 of 2025 and is dated 24 October 2025 (instrument header). The instrument contains its own internal amendment history insofar as it repeals the prior Statement relating to alcohol use disorder, being Statement No. 49 of 2017 (Federal Register of Legislation No. F2017L01046), made under subsection 196B(3) of the VEA (s4). It also states the commencement date as 24 November 2025 (s2).

What the instrument states about its genesis and status

• Made under subsection 196B(3) VEA. The authority to make the Statement is explicitly subsection 196B(3) of the VEA (s3). The instrument is therefore an exercise of statutory power granted to the Repatriation Medical Authority under the VEA.

• Replacement of earlier Statement. The instrument’s s4 records a clear repeal of the 2017 Statement. The instrument does not include a transitional provision that preserves determinations made under the repealed Statement, nor does it set out grandfathering rules. Therefore, application of the new Statement to pending claims will be a function of the administrative processes under the VEA/MRCA and the decision-makers’ approach to applying the new Statement to claims with events that occurred before commencement.

Absent amendment history in the instrument

• No schedule of prior amendments. The instrument does not contain an appendix of historical amendments or list of legislative changes beyond the repeal of the 2017 Statement. It does not, for example, list any prior minor amendments between 2017 and 2025.

• No transitional provisions provided. The instrument does not specify whether claims accepted or determined under the old Statement are to be reviewed or re-opened, nor does it set out the treatment of decisions already made. The practical effect of the repeal on existing decisions and appeals will depend on the VEA/MRCA statutory appeal and review framework and administrative policy.

Practical import for practitioners

• Check dates carefully. Because the instrument commences on 24 November 2025 (s2) but is dated 24 October 2025, practitioners must ensure the Statement in force for a particular claim is the 2025 Statement after the commencement date. The repeal of the 2017 Statement is absolute under s4 from the commencement date.

• Cross-reference other contemporaneous Statements. Section 11 requires that where a s9 factor refers to an injury or disease covered by another Statement, that other Statement will apply as in force from time to time. Practitioners should therefore compile and review the current versions of any cross-referenced Statements when preparing or defending claims.

• Monitor RMA publications. Any future amendment to this Statement will be via further action under subsection 196B(3) VEA. Practitioners should monitor Federal Register entries and the Repatriation Medical Authority’s publications for updates.

In short, the 2025 instrument replaces the 2017 Statement without providing transitional text. The practical consequences for pending or finalised determinations will turn on how decision-makers administer the repeal and apply the new Statement to claims across temporal boundaries.

The instrument does not record any litigation history. It is a stand-alone Statement of Principles document made under subsection 196B(3) of the VEA (s3), and contains no references to judicial decisions, tribunal decisions, appeals or precedent. There are no case names or litigation references in the text.

What this absence means for practitioners

• No internal case law to guide application. Because the instrument itself contains no litigation history, practitioners must rely on the underlying statutes (VEA, MRCA), administrative guidance from the Repatriation Medical Authority and any existing jurisprudence that interprets the VEA/MRCA and prior Statements of Principles. The instrument does not summarise or cite any prior administrative or judicial interpretations.

• Anticipated grounds for dispute. The instrument introduces several interpretive matters that are likely to form the basis of disputes and, potentially, litigation or tribunal appeals. Those include: the meaning and threshold of "related to the relevant service" (s10(1)); the interpretation of "inability to obtain appropriate clinical management" (s9); the proper application of DSM-5-TR criteria in medico-legal reports (s7(2)); the correct use of temporal windows for stressors and other factors; and the operation of s11 where other Statements are implicated. These areas are natural loci for argument, and if disputes reach courts or tribunals they will generate litigation history; none is recorded in the instrument.

• Need to consult contemporaneous decisions. Practitioners should therefore track VEA/MRCA tribunal decisions and Federal Court or AAT decisions that interpret how RMA Statements of Principles are applied, especially any decisions that deal with alcohol use disorder, DSM-5-TR interpretation, timing windows, and the "clinical worsening" limb.

• Administrative review bodies as common avenues. Given the administrative nature of the regime, disputes over how this Statement is applied will likely progress through internal reviews, merits review bodies and, where necessary, judicial review. Again, the Statement does not set these processes out, so practitioners must look to the procedural regimes in the VEA and MRCA for concrete procedural pathways.

Because the instrument contains no litigation references, the present document cannot cite or summarise case law. Practitioners should therefore treat the instrument as a new medical-evidentiary framework that will, over time, accumulate interpretive administrative and judicial authority through application in individual claims.

The instrument contains a number of technical and evidentiary features that commonly create traps for claimants, experts and decision-makers. These "gotchas" are points where small errors in factual presentation or misreading of the instrument are likely to be decisive.

1. Timing windows are strict and variable. Several qualifying factors have defined look-back periods tied to "clinical onset or clinical worsening": category 1A and 1B stressors within 2 years; category 2 stressors within 6 months; bereavement within 10 years; Roux-en-Y within 3 years; intimate partner violence within 2 years; smoking cessation window of 3 months; concussion or moderate/severe TBI within 3 years (s9, Schedule 1). The operative phrase is "before clinical onset or clinical worsening". Practitioners must ensure that dates of onset or worsening are precisely identified in medical evidence. Failure to do so may render otherwise relevant events outside the applicable window.

2. Distinction between "clinical onset" and "clinical worsening". Section 10(2) restricts the application of the clinical worsening aspects of s9 to circumstances where the alcohol use disorder was present before or during, but did not arise out of, relevant service. If onset occurred after service or as a direct consequence of service, the clinical worsening pathway is not engaged in the same way. Getting the chronology wrong will undermine claims.

3. "Related to the relevant service" is undefined and contestable. Section 10(1) requires that any s9 factor be related to the person’s relevant service. The Statement provides no bright-line test for "related to", which may invite disputes over whether an event that happened during or near service is legally connected to service rather than coincidentally temporally proximate.

4. Clinically significant disorder of mental health , no prior treatment required. The Schedule defines this term to include disorders warranting ongoing management but specifically notes that absence of actual management does not preclude the disorder being clinically significant (Schedule 1). This helps claimants who lacked treatment access, but misstatements in this area can mislead decision-makers if medical evidence does not explain why a disorder was clinically significant despite absent management.

5. Exclusion of alcohol-induced disorders without alcohol use disorder. The instrument explicitly excludes alcohol intoxication, withdrawal, and alcohol-induced mental disorders if the DSM-5-TR alcohol use disorder is not present (s7(2) note). Claims that rely on isolated alcohol-induced episodes without satisfying the DSM-style threshold will fail.

6. Smoking requirement nuance. The instrument requires that the person have "smoked tobacco at least 0.5 pack-years" before clinical onset or clinical worsening, and if smoking has ceased, the onset/worsening occurred within 3 months of cessation (s9(9), Schedule 1). Practitioners must calculate pack-years per the Schedule’s method and provide documentation of smoking frequency and cessation dates. Miscalculation or poor documentation creates a lost evidentiary issue.

7. Cross-reference complexity. Section 11 brings into play other Statements of Principles when s9 factors refer to injuries/diseases dealt with elsewhere. Practitioners must check the current wording of any referenced Statement because s11 states that those Statements apply "as in force from time to time". Relying on an obsolete version risks error.

8. "Inability to obtain appropriate clinical management" is open textured. The instrument lists inability to obtain appropriate clinical management before clinical worsening as a qualifying factor (s9(11)). What counts as "appropriate", what constitutes "inability", and how systemic barriers (for example geographical or financial) weigh in are matters for evidentiary proof and adjudicative judgment. Good supporting evidence will be necessary, but the Statement does not prescribe the form of evidence.

9. Roux-en-Y and surgical linkage. Having Roux-en-Y gastric bypass surgery within 3 years before onset/worsening is a discrete factor (s9(6)). Practitioners must connect surgical timing and post-surgical sequelae to alcohol use disorder onset or worsening. Mere past surgery without evidence of temporal or causal connection risks failure.

10. Witness limitations for category 1B events. The Schedule defines "witness" narrowly as someone who experiences an incident at the time it occurs and excludes persons exposed only to media coverage. Where a s9 factor depends on witness evidence (category 1B includes witnessing killing, atrocities, human remains etc.) practitioners should ensure that witness statements establish contemporaneous direct exposure per the Schedule.

11. Death definition and terminal events. The instrument treats death from a terminal event contributed to by alcohol use disorder as within scope, and Schedule 1 provides examples of terminal events (pneumonia, respiratory failure, cardiac arrest etc.). Establishing contribution to a terminal event requires medical causal opinion linking alcohol use disorder to the terminal event, which may be complex in multi-morbidity contexts.

12. Absence of transitional provisions on repeal. The instrument repeals the 2017 Statement (s4) but contains no transitional clause. Claims straddling the repeal date may require careful administrative argument as to which Statement applies.

13. Requirement to map clinical coding to DSM-5-TR. The instrument notes ICD-10-AM mapping but makes DSM-5-TR the operative definition (s7(3)-(4)). Practitioners should ensure clinical records coded under ICD-10-AM are translated into DSM-5-TR criteria in expert evidence. Over-reliance on ICD coding without DSM-5-TR analysis is a common evidentiary pitfall.

Addressing these gotchas requires precise chronological medical evidence, explicit causal linkage to relevant service, expert reports that map records to DSM-5-TR criteria, and careful attention to the Schedule’s definitional requirements.

For claimants, clinicians, advocates and decision-makers the practical compliance task is to assemble and present evidence that tracks precisely to the instrument’s diagnostic, temporal and relational requirements. The Statement creates an evidentiary checklist; compliance means meeting each relevant item on that checklist.

Core compliance steps

1. Establish the DSM-5-TR diagnosis. Medical evidence must demonstrate how the DSM-5-TR derived criteria in s7(2) are met: identify the specific symptoms (from the enumerated list), document their 12-month pattern, and address tolerance/withdrawal where relevant. Experts should explicitly state how the clinical records meet the DSM-5-TR items set out in the Statement, because the instrument makes DSM-5-TR the operative diagnostic standard (s7(2), Schedule 1).

2. Fix dates of clinical onset and clinical worsening. Because nearly every qualifying factor is tied to a look-back period measured from clinical onset or clinical worsening, clinicians should date onset and any clinically meaningful worsening in medical reports. Reports should explain the basis for those dates (for example first presentation, escalation of symptoms, hospitalisation, or documented change in pattern).

3. Map qualifying factors to Schedule definitions and time windows. Carefully identify which s9 factor(s) are relied upon, and show that they occurred within the specified time window before the clinical onset/worsening:

• Category 1A or 1B stressors: show occurrence within 2 years (s9(2)-(3), Schedule 1).
• Category 2 stressors: show occurrence within 6 months (s9(4), Schedule 1).
• Bereavement: death of a close person within 10 years (s9(5)).
• Roux-en-Y: surgery within 3 years (s9(6)).
• Intimate partner violence: within 2 years (s9(7), Schedule 1 definitions).
• Smoking: at least 0.5 pack-years and onset/worsening within 3 months of cessation if smoking ceased (s9(9), Schedule 1).
• Concussion/TBI: within 3 years (s9(10)).
• Inability to obtain appropriate clinical management: document attempts and barriers (s9(11)).

Use the Schedule’s defined meanings (for example what constitutes a "category 2 stressor") when making the factual case.

4. Demonstrate connection to relevant service. Provide evidence linking the factor(s) to relevant service as defined in Schedule 1 (eligible war service, defence service types, or peacetime service under MRCA). This may include service records, deployment logs, duty statements, or contemporaneous reports that place the qualifying event in a service context. Remember s10(1)’s requirement that any s9 factor be related to the person’s relevant service.

5. Where a s9 factor invokes another Statement, apply that Statement. If a factor refers to an injury/disease that has its own Statement of Principles, follow s11 and prepare evidence under that other Statement’s terms as they apply at the time of claim.

Evidence types to prioritise (practical checklist)

• Medical records that document symptoms, dates of onset, treatment encounters, psychiatric assessments and hospital admissions.
• Expert psychiatric opinion that maps clinical history and records to DSM-5-TR criteria, dates onset/worsening, and expresses an opinion on contribution to/causation by service-linked events.
• Service records and contemporaneous service documentation linking events or exposures to relevant service.
• Surgical records for Roux-en-Y; discharge summaries and operative notes to verify timing and complications.
• Smoking history documentation, corroborated where possible by medical notes, occupational health records, or statutory declarations that allow pack-year calculation per the Schedule (Schedule 1 method for pack-years).
• Records of concussion/TBI: incident reports, emergency department notes, neuroimaging reports, specialist neurology/neurosurgery letters.
• Records or reports documenting attempts to obtain clinical management where "inability to obtain appropriate clinical management" is relied upon: appointment rejections, waitlist evidence, financial or geographic barriers, referral refusals, or statutory declarations.
• Police, court or advocacy records to document intimate partner violence or other category 1A/1B events where criminal or administrative reports exist; witness statements that meet the Schedule’s definition of witness for category 1B events.
• Death certificates, coronial findings, medical records linking alcohol use disorder to terminal events for death cases (s7(6), Schedule 1 terminal event examples).

Expert report best practice

• Explicitly reference the Statement. The expert should state that they have considered the RMA Statement of Principles No. 86 of 2025 and explain how the evidence meets the criteria it sets out.
• Map records to DSM-5-TR items line by line. An explicit mapping avoids ambiguity and aligns the report with the instrument’s operative diagnostic standard.
• Provide causation and contribution opinions that address the relation to service. Experts should give a reasoned opinion about whether, on the balance of probabilities, the qualifying factor(s) related to the person’s relevant service materially contributed to or aggravated the alcohol use disorder, taking account of the timing requirements in s9 and the relationship requirement in s10.

Administrative practice points

• Identify which Statement applies to a claim: confirm whether the claim should be assessed under the 2025 Statement after 24 November 2025 or earlier rules for events decided before that date. The instrument repealed the 2017 Statement (s4), so verify which Statement is operative for each claim.
• Check for cross-references. If a factor points to another Statement, obtain and apply that Statement as per s11.
• Be precise on chronology. Mistakes on dates of onset, service events, or windows will be dispositive. Use multiple documentary sources where possible to triangulate dates.
• Prepare to explain absence of treatment. The Schedule allows for a clinically significant disorder to be found without prior management; an expert should explain why a disorder was clinically significant despite lack of treatment (Schedule 1 definition of clinically significant disorder).
• Anticipate contested subjective terms. Terms such as "appropriate clinical management" and "related to the relevant service" are contestable; therefore evidence should aim to reduce subjectivity by providing documentary corroboration and a clear chain of causation.

Record-keeping and preventative actions

• Clinicians treating current veterans should document baseline mental state, any alcohol-related behaviours, dates of exacerbation, and any barriers to accessing care. Those records will become critical if a claim arises.
• Service record accuracy: ensure that service incidents, postings, deployments and exposures are contemporaneously recorded and certified where possible.

By mapping evidence closely to the Statement’s diagnostic criteria, defined terms and time windows, and by supplying expert causal opinion that explicitly addresses both medical criteria and relation to relevant service, practitioners can comply with the instrument’s evidentiary architecture and reduce the risk of dismissal on technical grounds.