Statement of Principles concerning alpha-1 antitrypsin deficiency (Reasonable Hypothesis) (No. 33 of 2023)

The instrument operates through a compact set of legal-medical concepts that determine whether a claim involving alpha-1 antitrypsin deficiency is connected to relevant service. The principal concepts and their mechanical roles are:

• Alpha-1 antitrypsin deficiency: The instrument defines the condition as a genetic disorder of plasma protein metabolism involving reduced serum levels of alpha-1 antitrypsin (s 7(2)). The instrument notes common clinical manifestations such as emphysema and cirrhosis of the liver, but the operative definition is the genetic disorder and reduced serum levels. Death is covered when alpha-1 antitrypsin deficiency contributed to a terminal event or condition (s 7(3); Schedule definition of terminal event).

• Relevant service: The instrument applies only in the context of "relevant service" as defined in the Schedule. That term is defined to include various categories under the VEA and MRCA: operational, peacekeeping, hazardous and British nuclear test defence service under the VEA, and warlike and non-warlike service under the MRCA (Schedule). The Statement therefore does not operate outside those statutory service categories (s 5).

• Reasonable hypothesis standard: The Statement is explicitly titled "(Reasonable Hypothesis)". Section 9 sets out the factors that must at minimum exist before “it can be said that a reasonable hypothesis has been raised connecting alpha-1 antitrypsin deficiency or death from alpha-1 antitrypsin deficiency with the circumstances of a person's relevant service.” The instrument therefore prescribes the minimum factual predicates required to satisfy the “reasonable hypothesis” test that decision makers apply under the VEA/MRCA framework.

• Enumerated qualifying factors: The instrument prescribes at least one of two factors must exist (s 9):

  1. Smoking history measured in pack-years , having smoked tobacco products in an amount of at least 5 pack-years before the clinical worsening of alpha-1 antitrypsin deficiency (s 9(1)). The Schedule defines "one pack-year" as smoking 20 cigarettes per day for one year or an equivalent amount of tobacco products and supplies numerical equivalents and sample calculations.
  2. Inability to obtain appropriate clinical management for alpha-1 antitrypsin deficiency (s 9(2)). The instrument does not further define "appropriate clinical management" in the Schedule.

• Temporal and causal limits on application: Section 10 imposes a temporal and causal constraint. The factors in s 9 apply only to material contribution to, or aggravation of, alpha-1 antitrypsin deficiency where the condition was suffered or contracted before or during relevant service, but did not arise out of service (s 10(2)). Section 10(1) requires the existence of any factor in s 9 to be related to the relevant service rendered by the person.

• Interaction with other Statements: Section 11 provides that if a factor in s 9 refers to an injury or disease governed by another Statement of Principles determined under s 196B(2), then the other Statement’s factors apply according to that Statement as in force. This creates a cross-reference mechanism where the legal effect of overlapping or referenced conditions depends on other Statements.

• Definitions and measurement: The Schedule sets concrete measurement rules for pack-years and an equivalence table for tobacco products. It also supplies the Schedule definitions for MRCA, VEA, relevant service and terminal event. These definitions are normative for interpreting the factors.

Mechanically, the instrument moves from a biomedical description to legal thresholds. The biomedical description identifies the condition. The legal thresholds prescribe the factors that raise a reasonable hypothesis connecting the condition to service and narrow the circumstances in which those factors operate. The instrument therefore functions as a gatekeeper: it supplies medical-legal predicates that decision makers must consider when applying the VEA and MRCA statutory frameworks to claims involving alpha-1 antitrypsin deficiency.

The instrument explicitly applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (s 5). That situates its effect on the following groups:

• Claimants under the VEA and MRCA: Veterans and members of the Forces, including members of Peacekeeping Forces, who lodge claims under the specified provisions will have claims for alpha-1 antitrypsin deficiency assessed in light of this Statement. The instrument itself does not name beneficiaries or list benefits; it governs the evidentiary and medical nexus assessment used to determine whether a claim may be accepted under the governing Acts.

• Decision makers and medical advisers: The primary users of the Statement will be decision makers tasked with determining entitlement under the VEA or MRCA and the Repatriation Medical Authority and its medical assessors who provide medical guidance. The Authority prepared the Statement and sets out the factors that those decision makers must take into account in applying the “reasonable hypothesis” test (s 3, s 8).

• Dependants and estates: Because the instrument includes death from alpha-1 antitrypsin deficiency where the condition contributed to a terminal event or condition (s 7(3)), persons making claims on behalf of deceased veterans, or contesting entitlement in the case of death, will be affected by how the Statement operates. The Schedule defines “terminal event” to include causes such as pneumonia and respiratory failure, which are common proximate causes of death in advanced pulmonary disease.

• Medical practitioners and health records holders: The instrument’s factors require assessment of smoking history measured in pack-years (s 9(1) and Schedule). Medical practitioners, hospitals and other record-holders that document smoking history or clinical management will play an evidentiary role. The other mandated factor , inability to obtain appropriate clinical management (s 9(2)) , relies on clinical records, referral records and possibly systems-level documentation concerning access to care.

• Parties with overlapping conditions or linked Statements: Section 11 makes the instrument interact with other Statements of Principles where a factor refers to an injury or disease covered by another Statement. Thus persons whose alpha-1 antitrypsin deficiency claim intersects with another condition governed by a separate Statement will be affected by the terms of that other Statement.

The instrument narrows its operation temporally and causally. Section 10(2) limits the factors to material contribution or aggravation where the alpha-1 antitrypsin deficiency was suffered or contracted before or during relevant service, but did not arise out of service. That limitation excludes claims where the condition first arose out of the person’s service. Therefore claimants whose condition originated as a service-caused disease are outside the intended operation of these factors, as drafted.

Finally, the instrument affects administrators and lawyers who prepare claims because it sets out specific, measurable criteria for one factor (pack-years) and a less-defined criterion (inability to obtain appropriate clinical management). Practitioners will need to marshal different kinds of evidence depending on which factor is relied upon. The Schedule’s numerical definition of pack-years supplies a straightforward evidentiary target for smoking history whereas the clinical management factor is open to interpretation and will require qualitative and documentary proof.

The Statement creates legal thresholds and interpretative obligations rather than new duties or rights in the sense of criminal offence provisions or grant entitlements. The key operative duties and rights flow from the way the Statement is used in the VEA/MRCA decision-making process.

Duties on decision makers and medical assessors:

• To apply the Statement when a claim involving alpha-1 antitrypsin deficiency is before them. The Authority has determined the Statement under subsection 196B(2) of the VEA (s 3). That determination becomes the medical-legal basis decision makers use to assess whether a reasonable hypothesis exists connecting the condition to relevant service, as required by the VEA/MRCA frameworks.
• To accept as raising a reasonable hypothesis only where at least one of the enumerated factors in s 9 is present and related to relevant service (s 9; s 10(1)). The Statement prescribes the minimum factors decision makers should require to find a reasonable hypothesis.

Rights of claimants:

• The Statement establishes what must minimally exist to raise a reasonable hypothesis. Claimants have the right to present evidence to satisfy one or more of the factors set out in s 9 and to have their claim assessed against those factors under the applicable VEA or MRCA provisions (s 5).
• Where a factor in s 9 refers to another injury or disease covered by a different Statement, claimants benefit from the mechanism in s 11, which allows the terms of that other Statement to operate “as in force from time to time.” That cross-reference offers claimants a rights-preserving path where overlapping medical conditions are governed by separate Statements (s 11).

Interpretative duties arising from definitions:

• Decision makers must rely on the Schedule definitions when applying the factors. For example, smoking exposure for the s 9(1) factor is measured in "pack-years" as defined in the Schedule. The Schedule gives a specific unit (20 cigarettes per day for one year) and an equivalence in grams for other tobacco products, plus worked examples. Decision makers therefore have a duty to measure smoking exposure according to that Schedule definition when evaluating the s 9(1) factor.

Operational limits and duties:

• Section 10(2) imposes a duty to ensure that s 9 factors are applied only to material contribution to, or aggravation of, alpha-1 antitrypsin deficiency where the condition was suffered or contracted before or during relevant service but did not arise out of service. Decision makers must apply that temporal and causal limit. This creates an oppositional duty: if a condition arose out of service, s 9 factors do not apply for the purpose of establishing material contribution or aggravation under this Statement.

No direct duties on providers and no penalties:

• The Statement does not itself impose statutory duties on employers, medical practitioners or other third parties, nor does it prescribe penalties for non-compliance. It is an instrument that feeds into entitlement determinations under the VEA and MRCA. Any duties on third parties or penalties would arise from other statutory or regulatory sources, not from this Statement alone (see s 3 and s 5).

Practical implications for claim preparation:

• The Statement operationalises what claimants and their advisers must demonstrate to satisfy the reasonable hypothesis threshold. For smoking-related claims, quantitative evidence of smoking history measured against the Schedule’s pack-year definitions will be decisive in many cases. For claims based on inability to obtain appropriate clinical management, the Statement requires demonstration of access or service-level issues that prevented appropriate management, but does not define what qualifies as appropriate management, leaving room for clinical judgement and administrative interpretation at the decision stage.

In short, the Statement prescribes the minimum evidentiary factors decision makers must look for when determining whether a reasonable hypothesis connects alpha-1 antitrypsin deficiency to relevant service. It creates an evidentiary framework rather than direct statutory entitlements or duties on third parties, delegating the ultimate award of benefits and any reviewable decisions to the VEA/MRCA processes.

The instrument contains no penal provisions and does not itself create enforcement mechanisms, fines, or criminal offences. It is a Statement of Principles made under subsection 196B(2) of the VEA intended to guide entitlement determinations under the VEA and MRCA. Accordingly, the instrument’s legal effect is evidentiary and determinative for claim assessment, rather than punitive.

Key points drawn from the instrument about enforcement and remedies:

• No penalties: There is no section within the instrument that prescribes civil or criminal penalties for non-compliance by individuals, providers, or institutions. The Statement sets out the factors that must exist to raise a reasonable hypothesis connecting alpha-1 antitrypsin deficiency to relevant service; it does not create regulatory offences (the entirety of the instrument confirms its role as a Statement of Principles under s 196B(2) of the VEA).
• Enforcement via decision frameworks: The operational effect of the Statement is felt through the VEA and MRCA administrative processes. The instrument applies to claims under section 120A of the VEA and section 338 of the MRCA (s 5). Enforcement in the sense of achieving a benefit or remedy for a claimant depends on those Acts and the administrative decision-making and appeal mechanisms contained in them. The Statement itself does not articulate appeal routes, review rights or adjudicative processes. Those are provided by the governing Acts.
• Reliance by decision makers: The principal “enforcement” mechanism is that decision makers will use the Statement as the medical-scientific benchmark when applying the reasonable hypothesis standard. A failure by a decision maker to consider or correctly apply the Statement could be a ground for administrative review or judicial challenge under the VEA/MRCA frameworks; however, the Statement itself does not set out review mechanisms or remediable procedural steps.
• Evidence standard: The instrument sets out minimum factors that must exist for the reasonable hypothesis. The practical effect is that claimants who cannot establish one of the enumerated factors will find it difficult to have their claim accepted on this medical basis. This is not a penalty but a procedural gatekeeping role that affects claim outcomes.
• Interaction with other Statements and cross-references: Section 11 provides that where a factor in s 9 refers to an injury or disease governed by another Statement, the other Statement applies. That mechanism channels disputes over overlap to the content of those other Statements as they stand from time to time. It therefore creates a layered evidentiary architecture rather than an enforcement regime.

Because the instrument is silent on penalties and remedial procedures, enforcement in the practical sense will be executed through administrative action under the VEA and MRCA. Any consequences for decision makers, claimants or other parties arising from misapplication or disputes over the Statement will be handled within the remedies, reviews, and appeals available under those Acts and the general law. The instrument’s terms that can give rise to contested decisions include the measurement of pack-years and the interpretation of “inability to obtain appropriate clinical management”, both of which may be central to disputes that are then resolved under the processes established by the VEA and MRCA.

The instrument is expressly designed to operate within the statutory frameworks of the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). Its interactions with other laws are limited to references and cross-applications provided in the text.

Primary statutory interaction:

• Source and application: The Statement is made under subsection 196B(2) of the VEA (s 3). It applies to claims to which s 120A of the VEA or s 338 of the MRCA applies (s 5). That locates the instrument as an evidentiary tool used by decision makers applying those Acts. The instrument therefore does not itself create entitlements; it supplies medical findings that feed into the statutory decision-making mandated by the VEA and MRCA.

Interaction with prior Statements:

• Repeal of prior Statement: The instrument repeals the Statement of Principles concerning alpha-1 antitrypsin deficiency No. 29 of 2015 (s 4). That repeal indicates that the 2023 Statement replaces the 2015 Statement for the purposes of claims governed by the VEA and MRCA. Decisions and claims made after the commencement date (23 May 2023, s 2) will be assessed against this instrument rather than the repealed Statement.

Interaction with other Statements of Principles:

• Cross-application where factors refer to other injuries/diseases: Section 11 provides a mechanism for interaction with other Statements. If a factor in this Statement refers to an injury or disease that is covered by another Statement determined under s 196B(2) of the VEA, then the factors in that other Statement apply as in force from time to time. This creates an inter-Statement network where an element of proof that overlaps with another recognised condition will be determined according to that other Statement’s terms. The effect is that certain aspects of causation or contribution may be governed by alternative Statements rather than by this instrument alone.

Definitions and interpretive interaction:

• Schedule definitions incorporate MRCA and VEA: The Schedule defines MRCA and VEA and also defines “relevant service” by reference to categories under both Acts. This means the instrument’s application is contingent on statutory service categories established in those Acts. Interpreting whether service qualifies as “relevant service” will require reference to the definitions and tests in the VEA and MRCA themselves, not this Statement.

Absence of broader regulatory cross-references:

• No mention of workers compensation, health regulation, or other social security legislation: The instrument contains no express cross-references to other federal or state statutory schemes such as workers compensation, Medicare, or health professional regulation. Its drafting confines its interaction to the VEA and MRCA and other Statements determined under s 196B(2). Any operative link to non-Veterans’ schemes would therefore arise in practice through overlapping claims or through evidence created under those schemes, but the instrument does not itself stipulate such links.

Operational interaction for evidence:

• Pack-year measurement and tobacco equivalence: The Schedule supplies specific measurement rules for pack-years, including grams equivalence for pipe tobacco, cigars or combinations of tobacco products. That detail will be used by decision makers when assessing smoking history. The measurement rules therefore interact with clinical records and administrative evidence practices used in other contexts but are incorporated here as the controlling standard for this Statement.

Implications for review and appeals:

• The Statement itself does not set out procedural or review mechanisms; review and appeal processes operate under the VEA and MRCA and general administrative law. The instrument’s determinations will therefore be subject to the legal processes available under those Acts and the broader judicial review framework. The instrument does not alter those processes but supplies the medical-legal predicates that will be evaluated within them.

In summary, the Statement operates as a specialised evidentiary instrument integrated into the VEA/MRCA frameworks. It replaces a prior Statement and will interact with other Statements where factors overlap. Its practical operation requires decision makers to consult the VEA and MRCA for definitions and procedural rules while using the Schedule’s measurement rules and the s 9 and s 10 constraints to assess causation and contribution.

The instrument itself records a minimal but concrete amendment history within its text. The operative amendment events and dates in the document are these:

• Commencement: The instrument commences on 23 May 2023 (s 2). That is the date from which this Statement of Principles takes legal effect for the purposes of claims under the VEA and MRCA.

• Repeal of the prior Statement: Section 4 expressly repeals the Statement of Principles concerning alpha-1 antitrypsin deficiency No. 29 of 2015 (Federal Register of Legislation No. F2014L01837) which had been made under subsection 196B(2) of the VEA. The repeal is absolute; the 2015 Statement is removed from force and replaced by this new Statement as of the commencement date.

• Dated and sealed: The instrument is dated 24 April 2023 on its face and bears the Common Seal of the Repatriation Medical Authority attested by the Chairperson (front matter). However, the operative commencement date is 23 May 2023 as stated in s 2.

What the instrument does not record:

• No past amendment history within the instrument: There are no other amendments, revocations or schedules of prior amendments recorded inside the instrument beyond the repeal of the 2015 Statement.
• No future amendment schedule: The instrument does not specify any sunset clause, review timetable, or prospective amendments. It does not state a mechanism for automatic review or periodic update within the text.

Practical note for practitioners:

• Replaced document for evidentiary practice: The repeal means that decision makers and advisers must apply the 2023 Statement to relevant claims arising on or after the commencement date, and where applicable for decisions taken after that date, rather than the 2015 Statement. Records referencing the earlier Statement must be read in historical context and replaced in claim files by the new Statement where appropriate.

• Interaction with Statements “as in force from time to time”: Section 11 cross-references other Statements “as in force from time to time”. This wording means that while the instrument itself may be amended infrequently, its interaction with other Statements will necessarily respond to subsequent determinations or amendments to those other Statements; practitioners should therefore track changes to related Statements as well.

• Administrative publication details: The instrument identifies the prior Statement by its Federal Register of Legislation number, enabling practitioners to locate the repealed instrument in the legal register for archival or comparison purposes.

In short, the amendment history recorded within the instrument is limited to an express repeal of the 2015 Statement and the commencement date for the 2023 Statement. The instrument does not set out a broader amendment or review schedule.

The instrument contains no material addressing litigation history. It does not cite any cases, tribunal decisions, or past litigation that the Repatriation Medical Authority considered or relied upon in making the Statement. The text is confined to the medical definition, the factors necessary to raise a reasonable hypothesis, the temporal and causal limits, and the definitions in the Schedule.

Consequences of the absence of litigation references:

• No named precedents: The instrument does not identify judicial or administrative precedents as a basis for its determinations. Its statement that “there is sound medical‑scientific evidence” supporting a relationship between alpha-1 antitrypsin deficiency and relevant service (s 8) is a statement of the Authority’s view rather than a citation of case law.
• Evidentiary focus: Because the instrument is a medical-legal Statement prepared under statutory power, it is inherently evidentiary. Disputes over its application are likely to arise in the VEA/MRCA claims context and be resolved under those frameworks rather than by the Statement itself. The instrument does not record any contentious litigation surrounding its content or the medical conclusions.

Implications for potential dispute resolution pathways:

• Administrative review and appeal channels lie outside the Statement: The instrument’s silence on litigation history does not mean litigation cannot follow from decisions that apply the Statement. Claims rejected or accepted based on the Statement may give rise to appeals or judicial review under the VEA or MRCA and the administrative law framework. However, any such litigation would be grounded in the decision-making and procedural steps taken under those Acts, not in this Statement per se.

• Interpretative issues likely to generate dispute: The instrument contains elements that could be the subject of dispute in claims: the application of a 5 pack-year threshold (s 9(1) and Schedule definitions), the temporal requirement that the smoking exposure must be “before the clinical worsening” and the interpretation of “inability to obtain appropriate clinical management” (s 9(2)). While the instrument does not cite litigation, these are the axes along which claim disputes and possible judicial review might proceed in the VEA/MRCA administrative context.

• Cross-Statement interaction: Section 11 creates an interaction with other Statements of Principles where factors overlap. Litigation could arise over which Statement applies or how overlap is resolved. Again, the instrument does not record any such history.

Practical observation:

• Because the instrument is new (commencing 23 May 2023, s 2) and replaces a 2015 Statement (s 4), any litigation history that may exist concerning the 2015 Statement is not described in this document. Practitioners seeking precedent or litigation history will need to search case law and administrative decisions under the VEA and MRCA, and consider whether any past disputes about alpha-1 antitrypsin deficiency were recorded in judgments that addressed the earlier Statement.

In sum, the instrument itself provides no litigation history, case citations or references to disputes. It functions as a medical-legal standard that will be applied within the VEA and MRCA decision-making and review processes, and any litigation will arise from the application of the Statement within those statutory frameworks.

The instrument contains specific formulations and definitional choices that create concrete practical pitfalls for claimants, advisers and decision makers. The following are the principal "gotchas" grounded in the text:

1. Temporal restriction on the factors , not for conditions that "arise out of" service (s 10(2))

• The factors in s 9 apply only to material contribution to, or aggravation of, alpha-1 antitrypsin deficiency where the person’s condition was suffered or contracted before or during relevant service, but did not arise out of the person’s relevant service (s 10(2)). That means if a person’s alpha-1 antitrypsin deficiency first arose out of the service, the factors in this Statement are not the mechanism to show material contribution or aggravation. Claimants and advisers must check whether the condition "arose out of" service; if it did, then this Statement’s factors will not govern that causal question.

2. Smoking factor requires at least 5 pack-years and timing is important (s 9(1); Schedule)

• The smoking factor is not a general history of smoking; it requires an amount of at least 5 pack-years before the clinical worsening of alpha-1 antitrypsin deficiency (s 9(1)). The Schedule provides a precise measurement rule: one pack-year equals smoking 20 cigarettes per day for one year or equivalent amounts of other tobacco products, with worked examples and a grams equivalence (Schedule). Practically, a claimant who smoked fewer than 5 pack-years , even if they smoked at some point , cannot rely on s 9(1).

3. "Before the clinical worsening" is a temporal hinge (s 9(1))

• The smoking exposure must have occurred before the clinical worsening of the condition. The instrument does not define “clinical worsening”, creating an interpretive point of contention. Claimants will need to establish an onset or trajectory of disease consistent with their smoking history. Medical records that locate the timing of clinical worsening will therefore be critical.

4. "Inability to obtain appropriate clinical management" is undefined and open to interpretation (s 9(2))

• The second enumerated factor , inability to obtain appropriate clinical management , is not defined in the Schedule or the body of the instrument. That absence leaves room for administrative and medical interpretative discretion as to what counts as “appropriate” and what constitutes “inability to obtain” it. Evidence of referrals refused, services unavailable in a location, delays in access, or systemic barriers may be treated differently by decision makers. Practitioners must therefore prepare detailed evidence when relying on this factor.

5. Measurement and equivalence rules for tobacco products are technical (Schedule)

• The Schedule equates 1 gram of pipe tobacco or cigar tobacco to one cigarette and provides a grams equivalence example (7,300 grams = one pack-year for smoking tobacco by weight). Those rules will need careful application in records where tobacco consumption is recorded in weights, packets, or non-cigarette forms. Miscalculating pack-years by using informal conversions risks a failed showing under s 9(1).

6. Cross-Statement dependencies under s 11

• If a factor in s 9 refers to another injury or disease covered by another Statement of Principles, that other Statement applies as in force from time to time (s 11). Practitioners must check related Statements to ensure they are applying the correct provisions, because s 11 can import a different evidentiary regime.

7. The Statement is a threshold instrument, not the award standard

• The Statement raises the minimum required factors to establish a reasonable hypothesis. It does not guarantee acceptance of a claim or entitlement to benefits, and it does not replace the need to satisfy the substantive statutory tests and procedural requirements of the VEA or MRCA. Relying solely on the Statement without fulfilling statutory or evidentiary requirements under the VEA/MRCA will not secure an award.

8. Repeal of prior Statement: be careful with historical files (s 4)

• The 2015 Statement is expressly repealed (s 4). For claims involving events predating the repeal, advisers must be conscious of which Statement applies to the decision at hand and whether administrative processes or transitional provisions under the VEA/MRCA cause the earlier Statement to be relevant in particular circumstances. The instrument does not supply transitional wording, so administrative practice will be decisive.

9. No penalty provisions and no definitions for procedural proof

• The instrument does not specify what evidence suffices or how to prove inability to obtain appropriate clinical management or smoking quantities beyond the pack-year definition. Practitioners must therefore anticipate that decision makers retain discretion over evidentiary sufficiency and prepare documentation accordingly.

10. Terminal event definition affects death claims (s 7(3); Schedule)

• Death from alpha-1 antitrypsin deficiency is included only where the condition contributed to a terminal event or condition, and the Schedule defines terminal event in a list that includes pneumonia, respiratory failure and cardiac arrest among others. For death claims, practitioners must establish contribution to one of those proximate causes. If death records do not indicate such contribution, the death may fall outside the scope of s 7(3).

These textual features create interpretive and evidentiary risks. Practitioners should not assume that a history of smoking alone will suffice nor that the instrument applies to conditions that arose out of service. Record-keeping and precise dating of both smoking exposure and clinical progression will be pivotal. Similarly, reliance on the undefined concept of “appropriate clinical management” will require robust evidentiary support and expert clinical opinion.

Compliance in this context means preparing and presenting a claim that satisfies the minimum factors the Statement requires to raise a reasonable hypothesis connecting alpha-1 antitrypsin deficiency, or death from it, with relevant service. The instrument does not prescribe procedural steps, but its content points to specific documentary and evidentiary tasks for claimants and their advisers. The following actions follow directly from the instrument’s provisions and the Schedule definitions.

1. Identify the applicable statutory claim route

• Confirm that the claim is one “to which section 120A of the VEA or section 338 of the MRCA applies” (s 5). The Statement applies only within those statutory claim pathways. Ensure the claimant’s service falls within the Schedule definition of “relevant service” (Schedule), which lists the specific service types under the VEA and MRCA.

2. Establish the condition as alpha-1 antitrypsin deficiency or death from it

• Gather clinical records, genetic test results, serum alpha-1 antitrypsin levels, pathology reports and specialists’ opinions that establish the diagnosis as defined in s 7(2). If the claim is for death, assemble death certificates, clinical notes and cause-of-death information showing that alpha-1 antitrypsin deficiency contributed to a terminal event as defined in the Schedule (s 7(3); Schedule list of terminal event causes).

3. If relying on the smoking factor (s 9(1)), quantify smoking history to the Schedule standard

• Document the claimant’s smoking history in terms of pack-years and ensure the exposure preceded the clinical worsening of the condition. Use the Schedule’s definition of one pack-year (20 cigarettes per day for one year) and the equivalence rules for other tobacco products and weights. Provide contemporaneous medical notes, GP records, smoking cessation records, occupational health records, payroll records indicating purchase of tobacco if available, notarised statements, or other documentary sources that help calculate pack-years. The Schedule even supplies sample calculations; apply those methods to produce a clear pack-year total.

4. If relying on the clinical management factor (s 9(2)), document unavailability or denial of appropriate management

• Because “inability to obtain appropriate clinical management” is not defined in the Statement, assemble robust evidence that communicates both the clinical standard of care and the barriers to access for the claimant. This may include correspondence showing failed referrals, waitlist documentation, records of service unavailability at particular locations, letters from treating clinicians outlining missed or delayed treatments attributable to access barriers, and contemporaneous communications with health providers or government agencies. Expert clinical opinion that explains why certain interventions were appropriate and why they were not obtained will be important.

5. Establish temporal sequence and causal relation to relevant service (s 10)

• Ensure the smoking exposure or inability to obtain appropriate clinical management is shown to be related to the person’s relevant service (s 10(1)). For s 10(2) compliance, verify that the alpha-1 antitrypsin deficiency was suffered or contracted before or during relevant service and did not arise out of service. This will require matching dates of diagnosis, service records, and onset or progression of clinical signs. If the condition first arose out of service, this Statement’s factors are not the applicable pathway to establish material contribution or aggravation.

6. Cross-check other Statements where factors overlap (s 11)

• If any s 9 factor refers to an injury or disease covered by another Statement of Principles, obtain and apply that other Statement’s current terms as they are in force (s 11). This may affect evidence standards or introduce alternative factors.

7. Prepare expert medical evidence tailored to the Statement’s predicates

• Obtain a medical opinion that addresses the elements this Statement requires. For smoking factor cases, experts should: a) quantify pack-years using the Schedule method, b) link the smoking exposure temporally to clinical worsening, and c) explain how smoking could materially contribute to or aggravate alpha-1 antitrypsin deficiency. For clinical management factor cases, experts should explain standards of care, why the care was appropriate, and how inability to obtain it materially contributed to the condition’s worsening.

8. Document death claims with terminal event causation (s 7(3); Schedule)

• Where the claim concerns death, collect death certificates, post-mortem reports where available, hospital discharge summaries, and medical opinions tying alpha-1 antitrypsin deficiency to a terminal event (for example pneumonia or respiratory failure, which are listed in the Schedule). The Statement covers death only where the condition contributed to a terminal event.

9. Maintain clarity on the Statement’s role versus the statutory test

• Remember the Statement sets minimum factors to raise a reasonable hypothesis. Compliance requires integrating the Statement’s evidence into the broader statutory requirements and decision-making process under the VEA and MRCA. Ensure the claim file also addresses any non-medical statutory or procedural requirements in those Acts.

10. Track commencement and replacement of prior Statements

• The instrument commenced 23 May 2023 (s 2) and repealed the 2015 Statement (s 4). When preparing or appealing claims that straddle the repeal date, identify which Statement and which evidentiary standards apply to the decision under the VEA or MRCA processes.

11. Anticipate interpretative questions and prepare for them

• Expect decision makers to scrutinise timing of clinical worsening, the exact pack-year calculation, and the factual basis for any claimed inability to obtain appropriate clinical management. Provide contemporaneous documentation wherever possible rather than retrospective assertions.

By following these steps that track directly to the instrument’s text and Schedule, claimants and advisers can ensure their claim files address the precise predicates the Repatriation Medical Authority has set for raising a reasonable hypothesis linking alpha-1 antitrypsin deficiency to relevant service.