Statement of Principles concerning aortic aneurysm and aortic wall disorders (Reasonable Hypothesis) (No. 21 of 2021)

The SOP rests on several discrete legal and medical concepts, each expressed in statutory text and definitions.

• Condition scope: The instrument uses a bespoke definition of the covered conditions (s 7(2)). “Aortic aneurysm” is defined as “permanent dilatation of the wall of the thoracic or abdominal aorta” and “aortic wall disorders” is a list of named clinical entities including aortic dissection and symptomatic penetrating aortic ulcer. The Schedule provides more granular definitions for some entities, for example “aortic dissection” as separation of the aortic wall layers due to an intimal tear (Schedule 1).
• Reasonable hypothesis threshold: The SOP operationalises the “reasonable hypothesis” test by prescribing that “at least one” of the enumerated factors in s 9 must exist before it can be said a reasonable hypothesis has been raised. That is an evidential, not an entitlement, threshold. The instrument does not itself decide entitlement; rather it sets the minimal medical/factual basis that an assessing decision‑maker will use when applying the VEA/MRCA provisions identified in s 5.
• Onset versus worsening: The instrument separates factors that can cause or be associated with the clinical onset (subsections 9(1)-9(18)) from factors that can materially contribute to, or aggravate, clinical worsening (subsections 9(19)-9(36)). This separation is important because s 10(2) places a specific limit on the application of the worsening factors: they apply only where the person’s aortic disease “was suffered or contracted before or during (but did not arise out of) the person’s relevant service.”
• Relationship to relevant service: The statutory text requires each factor relied upon to be related to the person’s relevant service (s 10(1)). “Relevant service” is defined in the Schedule to include categories under both the VEA and MRCA, such as operational service, peacekeeping service, hazardous service, warlike and non‑warlike service (Schedule 1).
• Defined measurement thresholds and objective markers: Many factors are given precise, measurable definitions in the Schedule. Examples: obesity is BMI ≥ 30 (Schedule 1); chronic kidney disease requires abnormality present for at least three months and can be evidenced by GFR <60 mL/min/1.73 m2 (Schedule 1); dyslipidaemia is defined by specific serum cholesterol/triglyceride thresholds or ongoing lipid‑normalising therapy (Schedule 1); smoking exposure is expressed in pack‑years and quantified (Schedule 1).
• Cross‑application to other SOPs: Section 11 provides that where a factor in s 9 refers to an injury or disease for which another SOP exists, the factors from that other SOP apply “in accordance with the terms of that Statement of Principles as in force from time to time.” This mechanism embeds cross‑referencing among SOPs, meaning that a factor framed in terms of another definable injury/disease triggers the other SOP’s rules.

These concepts convert clinical and exposure information into discrete, catalogueable evidential items. The instrument is thereby designed to provide the decision process with objective thresholds (e.g., years of obesity, specific lab values, number of pack‑years, hours of second‑hand smoke exposure, timing windows for smoking cessation) which can be adduced by claimants and tested by decision‑makers.

This SOP directly affects three categories of stakeholders within the veterans’ compensation and rehabilitation framework and indirectly affects associated professionals.

• Claimants (veterans, members of Peacekeeping Forces, and members of the Forces covered by the MRCA): The instrument applies to claims where sections specified in s 5 (s 120A VEA or s 338 MRCA) are engaged. Practically, anyone asserting that their aortic aneurysm or aortic wall disorder (or death caused by such) is connected with relevant service will be affected because the SOP determines what minimal factors raise a reasonable hypothesis connecting the condition to service (s 9).
• Decision‑makers within the administrative scheme: Although the instrument does not itself name the decision-maker, it is expressly an SOP under s 196B(2) VEA and so will be used by the Department of Veterans’ Affairs and tribunals or decision‑makers applying the VEA/MRCA framework to assess whether there is a reasonable hypothesis (ss 3, 5, 8). The instrument supplies the medical benchmarks those decision‑makers use.
• Medical practitioners and experts preparing evidence: Because the SOP contains precise clinical and exposure thresholds, treating clinicians, forensic specialists, occupational health practitioners and medico‑legal experts will need to align their reports to the Schedule’s definitions when offering opinions on onset, causation, smoking history, BMI, metabolic markers, renal function, infection, drug exposure and similar matters.
• Records custodians and third‑party employers: The factors frequently require documentary evidence held outside the claimant’s personal notes , for example employment records showing exposure to second‑hand smoke or hours worked in enclosed spaces, military medical records for prescriptions (e.g., fluoroquinolones), surgical or transplant records, or public health COVID‑19 test records.
• Insurers and the Department: While the instrument does not itself alter payment rules, it will affect administrative exposure and the allocation of resources for claims assessment because it changes the evidentiary matrix (for both grant and rejection) used in adjudication.

Who pays and who decides? The instrument does not itself create payment obligations, nor does it specify which agency makes the ultimate entitlement decision. It is an RMA instrument used within the VEA/MRCA claim process (s 3, s 5). The SOP determines what evidence raises a reasonable hypothesis; entitlement, benefits and payments remain matters determined under the underlying VEA and MRCA legislative frameworks and their appropriate decision‑makers.

Behavioural and operational effects on stakeholders

• Claimant behaviour: The list of discrete factors will direct claimants and their advisers to assemble evidence for at least one of the s 9 factors. The presence of precise thresholds will direct clinical testing, record collection and witness statements targeted at the Schedule’s definitions (e.g., historical BMI records to prove five years of obesity; prescription records for fluoroquinolones in the three‑month window).
• Medical reporting: Clinicians will be incentivised to provide measurements and histories aligned to the Schedule thresholds, because otherwise a clinician’s opinion may not tie into the statutory definitions used to raise a reasonable hypothesis.
• Administrative handling: The Department and tribunals will use the SOP as a gatekeeping tool to determine whether the reasonable hypothesis threshold is met before proceeding to substantive causation and entitlement analysis.

This SOP does not itself create new rights to benefits nor new criminal or civil duties. Instead it prescribes how a reasonable hypothesis connecting the listed conditions to relevant service is to be recognised for the purposes of claims under s 120A of the VEA or s 338 of the MRCA (s 5). Still, the instrument creates de facto duties and practical rights within the claims process.

Duties (de facto, in claims process)

• Duty to link factors to relevant service: Any party relying on a factor from s 9 must connect that factor to the claimant’s relevant service. Section 10(1) requires that “the existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.” The duty is evidential: to establish the relationship in the claim record.
• Duty to apply the Schedule’s definitions when weighing factors: Because the Schedule supplies the operative definitions and numeric thresholds (e.g., BMI, lab values, pack‑year calculations), a decision‑maker applying this SOP will necessarily use those thresholds when determining whether a factor exists. Practitioners preparing evidence have a corresponding duty to provide evidence that maps to those thresholds where possible.
• Duty to treat onset and worsening factors differently: The instrument separates onset factors (9(1)-(18)) from worsening factors (9(19)-(36)), and s 10(2) limits the application of the latter. Decision‑makers and claimants must therefore be careful to select the correct subsection and satisfy the additional relational requirements under s 10(2).

Rights (procedural and evidential within the claims process)

• Right to rely on a listed factor to raise a reasonable hypothesis: A claimant has the right to advance any of the s 9 factors as sufficient to raise the statutory “reasonable hypothesis” threshold. The instrument requires only “at least one” factor (prefatory sentence to s 9).
• Right to objective, measurable criteria: The Schedule gives claimants a predictable set of criteria against which to frame medical evidence (for example, smoking cessation timing, pack‑year quantity, specific lipid thresholds, GFR numeric threshold, BMI formula and threshold). That predictability is a practical right to clarity in building a claim.
• Right to cross‑referenced SOPs: Where a factor in s 9 refers to an injury or disease for which another SOP exists, s 11 provides that the factors in that other SOP apply “in accordance with the terms of that Statement of Principles as in force from time to time.” That gives claimants a route to import the standards of other SOPs where relevant, but also imposes a duty to apply those other SOPs’ terms accurately.

Limits and caveats

• The SOP is not self‑executing as an entitlement. It operates within the VEA/MRCA claim framework. Establishing a reasonable hypothesis via the SOP is an evidential threshold; it does not automatically produce an award of benefits. The instrument itself contains no entitlements, payment schedules or penalties.
• Where a factor refers to another injury or disease covered by another SOP, parties must follow that other SOP’s terms (s 11). That creates a dependency risk where factors overlap multiple SOPs.

The key operational effect for decision‑makers and advisers is that the SOP constrains the types of admissible, legally recognised factors and prescribes precise thresholds. Parties preparing or defending claims must marshal evidence to the instrument’s definitions and meet the relational requirement in s 10.

The instrument does not create criminal offences, civil penalties, administrative fines, or enforcement mechanisms within its text. It is a determination under subsection 196B(2) VEA (s 3) and functions as a medical/evidentiary instrument used in assessing claims. The statutory provisions reproduced in this instrument do not specify sanctions for false statements, nor specify compliance penalties; those are matters that exist elsewhere in the VEA, MRCA, or general administrative law and fraud statutes, but are not set out in this SOP.

What the SOP does enforce in practice is evidentiary discipline within the claims process: decision‑makers will accept a reasonable hypothesis as raised only when the SOP’s conditions are met, so failure to provide evidence that meets the Schedule’s thresholds will result in an administrative rejection of the “reasonable hypothesis” component of a claim. The instrument therefore has an indirect enforcement effect in the sense that it governs acceptance or rejection of claims at an early evidential gate.

Who applies the SOP? The RMA issues the SOP (s 3); its status in adjudication flows from the VEA/MRCA claim processes (s 5). The SOP is a tool for the statutory decision‑makers who ultimately determine entitlement and benefits under the VEA/MRCA. The instrument itself does not identify those decision‑makers; it only makes clear that it “applies to a claim to which section 120A of the VEA or section 338 of the MRCA applies” (s 5).

Enforcement practicalities and evidentiary implications

• Administrative rejection risk: If a claimant cannot demonstrate at least one of the s 9 factors or cannot show a nexus to relevant service per s 10(1), the claim may fail at the reasonable hypothesis stage. That is an administrative outcome rather than a statutory penalty, but the practical effect is denial of compensation entitlements unless other legal routes are available.
• Evidence inspection: The SOP’s objective thresholds (lab values, cumulative exposure calculations, prescribed time windows) imply that decision‑makers will require documentary evidence (medical records, prescriptions, test results, employment records) to accept a factor. Absent such evidence, the SOP allows decision‑makers to find the factor unproven.

Limitations of the instrument for enforcement considerations

• No procedural rules: The SOP does not prescribe the burden of proof allocation, time limits for lodging evidence, dispute resolution processes, or appeal pathways. Those procedural elements are contained in the VEA/MRCA and associated regulations and are not part of this instrument.
• No penalty regime contained: Any misconduct (fraudulent evidence, false statements) would be dealt with under other statutes or under the VEA/MRCA administrative rules, not within this SOP.

In short, enforcement is indirect: the SOP is an evidentiary instrument that determines which medical/factual items meet the “reasonable hypothesis” gate; failure to meet those items results in the administrative consequence of a claim not being accepted at that threshold rather than in statutory penalties created by the SOP itself.

The SOP is squarely an instrument made under the VEA framework and is intended to be used within the VEA/MRCA claims process. The text itself provides specific cross‑interaction mechanisms and limitations.

Statutory provenance and immediate interactions

• Made under s 196B(2) VEA , instrument of the Repatriation Medical Authority: Section 3 states the authority for the instrument; section 8 records the RMA’s view on the medical evidence nexus. The SOP therefore interacts as a secondary instrument in the broader VEA legislative machine.
• Application to VEA and MRCA claims: Section 5 states the instrument applies to a claim to which s 120A of the VEA or s 338 of the MRCA applies. Those cross‑references mean the SOP is a component used in assessing claims under both Acts, so it will interact with procedural and substantive rules in each Act (even though those rules are not reproduced in the instrument).

Cross‑reference to diagnostic classification systems

• ICD‑10‑AM code note: Section 7(3)-(4) clarifies that although these conditions attract ICD‑10‑AM code I71, the SOP’s meaning is the statutory definition in s 7(2), not the ICD code alone. The instrument therefore displaces or supplements reliance on ICD codes for claims assessment, instructing decision‑makers to apply the instrument’s clinical definitions.

Cross‑application with other Statements of Principles

• Section 11 is a governance device for overlapping medical conditions: If a factor in s 9 “refers to an injury or disease in respect of which a Statement of Principles has been determined,” then that other SOP governs the factor “in accordance with the terms of that Statement of Principles as in force from time to time.” In practice, this creates an interoperability requirement among SOPs. When a factor depends on an element covered elsewhere (for example, a specified infection or an autoimmune disease), the decision‑maker must apply the other SOP’s standards and any amendment history for that SOP.

Interaction with administrative decision‑making and evidentiary law

• The SOP supplies medical/factual benchmarks but does not alter the tests in the VEA or MRCA regarding entitlement, causation beyond the reasonable hypothesis threshold, or allocation of legal burdens. The instrument creates a legal presumption only to the extent the claim assessment rules in the VEA/MRCA treat a raised reasonable hypothesis as a threshold for further consideration. The SOP itself does not set or modify evidentiary burdens; it creates a structured approach for establishing one element of causation within the statutory scheme.

Indirect interaction with health, criminal and insurance law

• The SOP refers to matters that can implicate other legal regimes , e.g., drug use (specified list of illicit drugs in Schedule 1), organ transplant records, SARS‑CoV‑2 infection , but it does not change the legal status of those topics in other fields. For instance, identification of methamphetamine use as a factor for aortic wall disorders (Schedule 1 specified list) may be relevant evidentially within a claim but does not itself change criminal law, public health reporting obligations, or insurance policy coverage rules. Those intersections exist in practice but are governed by other statutes and rules.

Practical touchpoints for cross‑application

• Use of clinical thresholds that match commonly accepted clinical practice standards will facilitate integration with health records and medical evidence; however where the SOP’s thresholds deviate from typical clinical recording practice, administrative friction may arise (for example, the requirement to quantify second‑hand smoke exposure in hours).
• Where a factor requires reliance on another SOP (s 11), decision‑makers and advisers must track amendment histories of multiple SOPs, because s 11 references “as in force from time to time.” That could cause timing and retrospective application issues if SOPs are amended.

In sum, the SOP is an instrument embedded in the VEA/MRCA legal architecture. Its primary interaction is with the claim assessment and evidentiary rules of those Acts, while it also cross‑references other SOPs and medical classification systems (ICD‑10‑AM) and thereby requires claim administrators to handle interoperable standards.

The compiled instrument includes amendments up to the Veterans’ Entitlements (Statements of Principles,definition of "one pack‑year") Amendment Determination 2022 (No. 94 of 2022) (F2022L01128). The compilation date is 19 September 2022 (front matter). The endnotes provide a precise chronology of registration and commencement events for the SOP and for the pack‑year amendment.

Key dates and entries from the endnotes

• Original instrument: Statement of Principles concerning aortic aneurysm and aortic wall disorders (No. 21 of 2021) , registered 4 January 2021, commenced 25 January 2021 (Endnote 3).
• Amendment: Veterans' Entitlements (Statements of Principles,definition of "one pack‑year") Amendment Determination 2022 (No. 94 of 2022) , registration 26 August 2022, commencement 19 September 2022 (Endnote 3).

Scope of amendments recorded in the compilation

• Endnote 4 (Amendment history) records that specific notes to subsections 9(4), 9(5), 9(22), and 9(23) were revised by rs No. 94 of 2022, and that the Schedule 1 definition of “one pack‑year” was replaced by that instrument (Endnote 4 table). The compilation states that the effect of that Amendment Determination is included as of its commencement date, 19 September 2022.

What the amendment did (as shown in the instrument)

• The Schedule now contains a specific numeric equivalence for “one pack‑year” and explanatory notes that define an “equivalent amount of tobacco products” (Schedule 1, one pack‑year). The Schedule sets out that an equivalent amount is 7,300 grams of smoking tobacco by weight, and for pipe tobacco, cigars or combinations, 1 gram equals one cigarette. The Schedule also contains the pack‑year calculation formula and examples (e.g., 10 cigarettes per day for 10 years = 5 pack‑years; 40 cigarettes per day for 10 years = 20 pack‑years).
• Notes to the smoking cessation factors in s 9(4), s 9(5), s 9(22), and s 9(23) were updated to reflect the amended definition of one pack‑year (Endnote 4).

Compilation notes

• The compilation alerts readers that uncommenced amendments are not shown in the text and that the compilation date is 19 September 2022 (front matter). It also advises that where amendments have application, saving or transitional provisions external to this compilation exist, those are identified in the endnotes (front matter).

Practical consequences of the amendment

• The amendment made the pack‑year metric concrete and numerically precise, which reduces uncertainty around calculating smoking exposure for the thresholds in s 9 (onset and worsening factors). This has evidentiary consequences: claimants and decision‑makers now use a common numeric standard (7,300 grams = 1 pack‑year equivalence for non‑cigarette tobacco) and the pack‑year formula for conversion.
• The amendment history indicates the SOP is a living instrument subject to targeted changes (for example, definitional clarifications), which affects practitioners’ need to monitor SOP versions , particularly given s 11’s instruction that other SOPs apply “as in force from time to time.”

No other amending instruments are recorded in the compilation beyond the original 2021 SOP and the 2022 pack‑year amendment. The endnotes provide the administrative trail necessary for an adviser to verify which version of the SOP applies at the time of a claim.

The instrument itself does not reference any court or tribunal decisions, and the compilation contains no reported litigation history. The endnotes in this compilation outline the administrative legislative history and amendment history (Endnotes 3 and 4) but do not include any judicial or administrative determinations that interpret or litigate this specific SOP. Consequently, within the text provided:

• There are no cases named in the instrument.
• There is no recorded litigation that has tested or interpreted the application of the listed factors, their thresholds, the relationship to service, or the operational effect of the SOP.

Practical implications of the absence of litigation history in the compilation

• Unresolved interpretive questions: Because the SOP is detailed in its definitions and thresholds but the compilation does not include any judicial interpretation, practical ambiguities (for example, how strictly a decision‑maker must quantify “being exposed to second‑hand smoke for at least 1,000 hours”) remain to be clarified through decision‑making practice or future litigation. Practitioners should therefore be attentive to administrative decision records and tribunal determinations in the VEA/MRCA system for emerging interpretive guidance.
• Reliance on statutory text and medical evidence: In the absence of litigation, decision‑makers are more likely to rely on the plain language of the SOP and on clinical evidence when applying it. The Schedule’s numeric thresholds and examples will therefore often be determinative unless and until challenged and judicially or administratively refined.
• Monitoring tribunal outcomes: Advisers and affected parties should monitor Veterans’ Review Board or AAT decisions applying this SOP (not supplied in this compilation) to identify how doctrinal issues, evidentiary weighing and the application of s 10(2) are being interpreted.

Because the SOP is an administrative, technical tool within the VEA/MRCA framework, the practical test cases will arise in administrative decisions and tribunal appeals rather than in criminal or civil courts. Any litigative history that arises would be recorded outside this instrument (in tribunal or court databases) and should be checked by advisers handling claims, given the potential for interpretive evolution.

The SOP contains many technically consequential details that can trip up claimants, medical witnesses, and decision‑makers if not handled precisely. The following are concrete pitfalls that arise from the instrument’s text and definitions.

1. “At least one” factor is necessary but must be related to relevant service (s 9; s 10(1))

• Pitfall: A claimant may establish a listed factor (for example, obesity or prior smoking) but fail to show the required connection to relevant service. The instrument requires both the factor and that it be related to service (s 10(1)), so evidence must show how the factor arose in or was affected by relevant service rather than simply existing in the claimant’s life.

2. Onset versus worsening factors, and the special limit in s 10(2)

• Pitfall: The instrument separates onset (9(1)-(18)) and worsening (9(19)-(36)). Subsection 10(2) limits the worsening factors to situations where the condition “was suffered or contracted before or during (but did not arise out of) the person’s relevant service.” If a claimant’s aortic condition arose out of service, the worsening factors in 9(19)-(36) are not available to show material contribution or aggravation under this SOP. That nuance will affect both case selection and evidentiary strategy.

3. Numeric and time thresholds that require quantification and documentary proof

• Examples: being obese for “at least five years within the 20 years before clinical onset” (s 9(2)); smoking thresholds expressed in pack‑years and timing of cessation (s 9(4)-(5), s 9(22)-(23)); second‑hand smoke exposure expressed in hours (1,000 or 5,000 hours) and cessation time windows (s 9(6)-(7), s 9(24)-(25)). The Schedule formalises pack‑year calculations and equivalences (Schedule 1).
• Pitfall: These thresholds will often be hard to prove retrospectively, particularly for lifestyle metrics (dietary intake, second‑hand smoke hours, historical BMI). Decision‑makers will expect contemporaneous records where possible.

4. “Inability to consume an average of at least 100 grams per day of any combination of fruit and vegetables” (s 9(10); s 9(28))

• Pitfall: Proving inability to consume 100 g/day over a five‑year period within the 20 years before clinical onset/worsening is unusual evidence to collect. Medical records rarely quantify dietary intake precisely, and claimants may struggle to provide objective proof. This factor is susceptible to subjective assessment and will require corroborating evidence (e.g., clinical diagnoses causing malabsorption, enteral feeding records, hospital/nursing notes).

5. Second‑hand smoke exposure quantified in hours (s 9(6)-(7), s 9(24)-(25))

• Pitfall: The Schedule defines “being exposed to second‑hand smoke” as being in an enclosed space inhaling smoke from burning tobacco products or exhaled smoke (Schedule 1). The SOP requires proof of cumulative hours (1,000 or 5,000) and cessation windows. Employment histories, rosters, unit diaries, or witness statements may be necessary, but such granular retrospective evidence is often absent.

6. Pack‑year definition and 7,300 g equivalence (Schedule 1)

• Pitfall: The amendment clarifies an “equivalent amount” as 7,300 g of smoking tobacco by weight, and equates 1 g of pipe tobacco or cigars to one cigarette. These conversion formulas can materially affect whether a claimant meets the pack‑year thresholds. Failure to apply the amended definition could produce calculation errors.

7. Specified list of drugs and narrow timing windows (s 9(18)(e), s 9(35)(e), Schedule 1)

• Pitfall: The list of specified drugs (MDMA, amphetamine, cocaine, crystal methamphetamine, methamphetamine) is finite and the timing window for some factors is short (e.g., taking a drug from the specified list in the 72 hours before clinical onset/worsening for aortic wall disorders). Claimants relying on drug exposure must show contemporaneous records, toxicology or credible witness evidence.

8. Fluoroquinolone exposure window (s 9(17), s 9(34))

• Pitfall: The SOP treats taking a fluoroquinolone antibiotic in the three months before onset/worsening as a factor. Prescription records and pharmacy dispensing records will be decisive. Absent records, opinions based on recall may be insufficient.

9. SARS‑CoV‑2 infection timing (s 9(18)(f), s 9(35)(f))

• Pitfall: The instrument includes infection with SARS‑CoV‑2 “at the time of the clinical onset/worsening” as a factor. Given the variability of testing, timing evidence (PCR test dates or clinical diagnoses) will be necessary to establish the infection’s timing relative to the aortic event.

10. “Inability to obtain appropriate clinical management” (s 9(36))

• Pitfall: This factor is potentially broad and fact‑sensitive. Claimants must show both inability to obtain appropriate management and that this inability contributed to clinical worsening. The SOP contains no definition of what counts as “appropriate clinical management” or measurable thresholds for inability, so evidence will need to be specific (medical referrals refused, services unavailable in a location, documented delays in critical intervention).

11. The ICD‑10‑AM code I71 is not determinative (s 7(3))

• Pitfall: A claimant or decision‑maker who relies only on administrative coding (I71) without showing the condition meets the statutory meaning in s 7(2) may fail to establish a relevant condition. The SOP’s definitions override mere ICD coding for the purposes of raising a reasonable hypothesis.

12. Cross‑SOP dependencies (s 11)

• Pitfall: Where a factor references another disease or injury that has its own SOP, the other SOP’s terms apply. This can create complexity and a need to apply multiple SOPs and amendment histories concurrently.

13. Pregnant period for aortic wall disorders (s 9(18)(b), s 9(35)(b))

• Pitfall: The timing window is six weeks before clinical onset/worsening. Claims relying on pregnancy must show evidence of the pregnancy and its timing relative to the aortic event.

The common theme in these gotchas is that the SOP provides numerically precise and narrow windows for factors; the evidentiary task is to match documentary or clinical evidence to those precise statutory thresholds. Where evidence is lacking, claims will fail to meet the reasonable hypothesis gate even if medically plausible.

This section gives a practical checklist for claimants, clinicians and advisers preparing to rely on this SOP in a VEA/MRCA claim. The SOP requires showing the condition per s 7(2), establishing at least one factor from s 9 with documentary or clinical support, and proving that the factor is related to relevant service per s 10(1). When relying on worsening factors (9(19)-9(36)) pay close attention to s 10(2).

1. Ascertain the correct condition definition

• Use s 7(2) and Schedule 1 definitions to confirm the claimant’s clinical diagnosis fits the SOP’s definition (for example, permanent dilatation = aortic aneurysm of thoracic/abdominal aorta; aortic dissection defined in Schedule). Do not rely solely on ICD‑10‑AM code I71 , s 7(3) makes the SOP’s definition determinative for these purposes.

2. Map the claim to onset or worsening factors

• Determine whether the claim concerns clinical onset (subsections 9(1)-(18)) or clinical worsening/material contribution (subsections 9(19)-(36)). If alleging worsening, confirm the condition was suffered or contracted before or during the relevant service and “did not arise out of” the service, per s 10(2). If the condition arose out of service, the worsening factors in 9(19)-(36) do not apply under this SOP.

3. Select the most provable factor(s)

• The SOP requires at least one factor. Prioritise factors that are most likely to have supporting contemporaneous records. Examples of relatively documentary factors: hypertension (medical records), chronic kidney disease (GFR < 60 and ≥ 3 months medical records), fluoroquinolone prescription in the relevant three months (prescription/pharmacy records), organ transplant (surgical/transplant notes), HIV infection (lab records), infection with organisms affecting the aorta (microbiology, imaging, surgery reports).

4. Collate supporting evidence per Schedule thresholds

• Smoking: Use the amended pack‑year definition in Schedule 1 to calculate pack‑years. Secure medical notes, military service medical records, pharmacy records, or credible witness statements to support daily cigarette consumption and duration. For cessation thresholds (e.g., clinical onset within 20 years of cessation for 1-5 pack‑years), provide clear dates for cessation.
• BMI/obesity: Provide recorded weights and heights across the relevant period demonstrating BMI ≥ 30 for at least five years within the relevant 20‑year window. Clinic notes, hospital records, and military health records are useful.
• Dyslipidaemia: Produce laboratory results showing the thresholds in Schedule 1 (HDL < 1.0 mmol/L, LDL > 4.0 mmol/L, triglycerides ≥ 2.0 mmol/L, total cholesterol > 5.5 mmol/L) or evidence of regular lipid‑normalising therapy.
• Second‑hand smoke: Assemble workplace records, postings, station/unit rosters, accommodation records, or witness statements to estimate cumulative hours in enclosed spaces where smoking occurred. For cessation windows, show last exposure dates.
• Dietary intake: If relying on inability to consume ≥ 100 g/day fruit/veg for five consecutive years, provide clinical evidence of malnutrition, swallowing disorders, gastrointestinal disease, or documentation of feeding restrictions; contemporaneous dietetic or hospital records are highly persuasive.
• Infective causes: Provide microbiology, imaging, surgical, and pathology reports confirming aortic infection or organism identification where eligible.
• Fluoroquinolones and specified drugs: Provide prescription, dispensing or toxicology evidence showing exposure within the time windows (three months for fluoroquinolones; 72 hours for specified illicit drugs related to aortic wall disorders).
• SARS‑CoV‑2: Provide PCR or antigen test dates, admission records or clinician notes documenting infection “at the time” of the aortic event.
• Physical exertion: For the 5 METs threshold in relation to aortic wall disorders, secure wearable or fitness records, contemporaneous witness accounts, or clinician statements translating the activity to METs.

5. Demonstrate nexus to relevant service (s 10(1))

• Prepare evidence connecting the chosen factor to the claimant’s relevant service. Typical evidence includes service medical records showing onset or persistence of the factor during service, deployment diaries, unit rosters for exposure metrics, or contemporaneous treatment notes showing service‑era diagnosis of hypertension, dyslipidaemia, or kidney disease. Where necessary, obtain statements from treating service medical officers explaining how the factor related to duties or exposures.

6. If a factor refers to another SOP, obtain the other SOP’s requirements (s 11)

• Where a factor invokes another injury or disease covered by a different SOP, obtain that SOP and apply its terms and thresholds “as in force from time to time” (s 11). Document the cross‑SOP evidence to ensure consistency.

7. Anticipate and address potential evidentiary weaknesses

• Where subjective or cumulative exposures are alleged (hours of second‑hand smoke, dietary inability, hours of exposure), collect corroboration: co‑worker statements, employer records, unit logs, health facility restrictions, or military accommodation records.
• For claims relying on “inability to obtain appropriate clinical management” (s 9(36)), document attempted contacts for care, referrals refused, geographic limitations, waiting lists, dates and content of correspondence with health providers or the Department, and any contemporaneous evidence that appropriate interventions were unavailable.

8. Use clinicians familiar with Veterans’ claims and SOP thresholds

• Ask treating physicians and medico‑legal experts to couch their opinions in terms of the SOP’s definitions and thresholds, for example addressing whether BMI records meet the five‑year requirement, or whether a fluoroquinolone course was within the three‑month window. Expert statements that explicitly map clinical findings to the SOP reduce the need for administrative reinterpretation.

9. Verify applicable version of the SOP and amendment history

• The instrument is amendable (see Amendment history). Make sure the version in effect at the time of the relevant claim event is used, particularly for matters affected by the 2022 amendment to the pack‑year definition. Section 11’s cross‑reference to other SOPs also requires checking those SOPs’ current versions.

10. Prepare for the possibility of overlapping evidence or multiple SOPs

• Some factors overlap other medical conditions (for example, autoimmune aortitis referencing diseases like rheumatoid arthritis). Where overlap exists, compile evidence applicable to both the aortic SOP and the other SOP(s) to avoid procedural rejection under s 11.

Summary checklist

• Confirm diagnosis meets s 7(2) definition.
• Identify onset or worsening pathway and applicable s 9 factor(s).
• Quantify exposures using Schedule 1 metrics (BMI, pack‑years, GFR, lipid thresholds, hours).
• Collect contemporaneous records (medical records, lab tests, prescriptions, service records, employment logs, travel logs).
• Obtain expert medical opinions mapping clinical facts to the SOP’s thresholds.
• Demonstrate nexus between the chosen factor and relevant service per s 10(1).
• Confirm the applicable version of the SOP and cross‑referenced SOPs per s 11.

Following these steps aligns evidence to the SOP’s precise thresholds and relational requirements and reduces the risk that a claim fails at the reasonable hypothesis stage for lack of properly framed and documented proof.