Statement of Principles concerning Barrett oesophagus (Balance of Probabilities) (No. 94 of 2025)

The instrument is short and conceptually focused. The principal concepts are: the clinical definition of Barrett oesophagus; the notion of death “from” Barrett oesophagus; the list of causal factors that can support a service connection; temporal and relational rules for those factors; the statutory vehicles to which the SoP applies; and the interaction with other SoPs.

Meaning of Barrett oesophagus. The SoP supplies a clinical definition: Barrett oesophagus means metaplasia of the epithelium of the lower oesophagus from stratified squamous epithelium to abnormal columnar epithelium, and includes metaplasia at the gastro‑oesophageal junction (s 7(2)(a)-(b)). The instrument recognises the relevant ICD‑10‑AM code (K22.7) but states that, for the purposes of the SoP, the statutory meaning is the textual definition in subsection 7(2) rather than merely the code (s 7(2)-(3)).

Death from Barrett oesophagus. The SoP treats death as within scope where a terminal event or condition was contributed to by the person’s Barrett oesophagus (s 7(4)). The Schedule defines “terminal event” to include proximate or ultimate causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure or cessation of brain function (Schedule 1).

Causation standard. The title and the Authority’s statement frame the standard of proof as balance of probabilities. The Authority states that, on the sound medical‑scientific evidence available, it is of the view that it is more probable than not that Barrett oesophagus and death from it can be related to relevant service (s 8). The SoP therefore identifies factors which, if established and otherwise related to relevant service, satisfy the Authority’s view for causation on that civil standard.

Factors and temporal thresholds. Section 9 lists the factors one or more of which must exist before the connection can be made on the balance of probabilities. The listed factors include: a history of gastro‑oesophageal reflux disease for at least two years before clinical onset or clinical worsening; presence of hiatus hernia before onset/worsening; specified obesity measures (BMI ≥30 or waist circumference thresholds) for at least five years before onset/worsening; systemic sclerosis before onset/worsening; and inability to obtain appropriate clinical management before clinical worsening (s 9(1)-(6)). The instrument sets out how BMI is calculated (note to s 9): BMI = W/H2 with W in kilograms and H in metres.

Relationship to service. The SoP requires that any factor relied on must be related to the person’s relevant service (s 10(1)). The clinical‑worsening pathway is constrained: it applies only where the Barrett oesophagus was suffered or contracted before or during the relevant service and the service materially contributed to, or aggravated, the condition, but did not give rise to it (s 10(2)).

Relevant service categories and cross‑referencing. The Schedule defines “relevant service” to mean eligible war service (other than operational service) under the VEA, defence service (other than hazardous service and British nuclear test defence service) under the VEA, or peacetime service under the MRCA (Schedule 1). The SoP also provides a mechanism for interaction with other SoPs: if a factor refers to an injury or disease covered by another SoP, then the factors in that other SoP apply as that SoP is in force from time to time (s 11).

Authority and scope. The Repatriation Medical Authority made the SoP under the statutory power in s 196B(3) of the VEA (s 3). The SoP applies to claims falling within the specified sections of the VEA and MRCA and replaces the prior Barrett oesophagus SoP made in 2016 (s 4-5).

The instrument affects three overlapping sets of actors: claimants (veterans and members of the Forces whose claims fall under the specified statutory sections), decision makers who apply Statements of Principles to claims under the VEA or MRCA, and, indirectly, medical practitioners and record‑keepers who supply the clinical evidence used in claims.

Claimants. By the instrument’s application clause, it applies to a claim to which section 120B of the VEA or section 339 of the MRCA applies (s 5). The Schedule defines “relevant service” so that the affected claimant population for these claims will be those whose service is within one of the listed categories: eligible war service (other than operational service), defence service (other than hazardous service and British nuclear test defence service) under the VEA, or peacetime service under the MRCA (Schedule 1). For those claimants, the SoP creates the medical causation framework they must satisfy to establish that Barrett oesophagus, or death from it, is connected with their relevant service.

Decision makers. The SoP is made under s 196B(3) VEA and is a determinative Statement of Principles for the purposes of the statutory scheme as expressed in the instrument (s 3). The instrument identifies the set of medical factors which, when established and related to relevant service, meet the Authority’s view on causation on the balance of probabilities (s 8-9). Although the instrument does not recite the decision‑making procedures or identify which tribunal or department will apply it, the SoP’s legal operation is to inform claims assessments under the cited provisions of the VEA and MRCA (s 5).

Medical practitioners and records custodians. The SoP is evidence‑driven. It specifies clinical diagnoses, durations, objective thresholds (BMI and waist circumference), and events (hiatus hernia, systemic sclerosis, inability to obtain appropriate clinical management) that must be established. Medical records that show the history of gastro‑oesophageal reflux disease, imaging or endoscopy confirming hiatus hernia or Barrett metaplasia, measurements of weight/height or waist circumference over the requisite periods, and documentation of any failure to obtain appropriate clinical management will be the primary materials that claimants must produce to demonstrate a factor in s 9.

Other SoP authors and users. Section 11 creates an ongoing interaction between this SoP and other SoPs. Where a factor in s 9 refers to an injury or disease covered by another SoP, that other SoP’s factors apply as in force from time to time (s 11). That means updates to related SoPs can change how cross‑referenced factors are applied to Barrett oesophagus claims, affecting both claimants and decision makers who rely on the interlocking SoPs.

No penalties or criminal sanctions are created by the instrument itself. The SoP states causal thresholds and definitions but does not impose fines, imprisonment, or administrative penalties. Enforcement in relation to claims will occur through the claims processes under the VEA and MRCA; the instrument does not itself set out enforcement machinery (s 3-5).

This instrument does not create freestanding duties or private rights in the way a statute might. Instead it prescribes the medical criteria that must be established for a claimant to satisfy the Repatriation Medical Authority’s view on causation on the balance of probabilities. The relevant duties and rights arise through the effect the SoP has on claim assessments under the VEA and MRCA as specified.

Duty to show one or more specified factors. For a finding that Barrett oesophagus, or death from it, is connected with relevant service on the balance of probabilities, at least one factor listed in section 9 must exist (introductory text to s 9, s 9(1)-(6)). The claimant therefore bears the practical duty of establishing evidence of such a factor in their claim file.

Duty to establish temporal thresholds and relation to clinical onset/worsening. Each factor is subject to a timing requirement relative to “clinical onset or clinical worsening.” For gastro‑oesophageal reflux disease the required duration is at least two years prior to clinical onset or clinical worsening (s 9(1)). For the BMI or waist circumference factors the required duration is at least five years immediately preceding clinical onset or clinical worsening (s 9(3)-(3)(a)-(c)). The claimant must present evidence that these durations and the timing relative to clinical onset or worsening are met.

Duty to link factors to relevant service. Section 10(1) requires that any factor relied on must be related to the person’s relevant service. That relational requirement imposes a service‑connection element on the evidence the claimant must adduce. For factors used under the clinical‑worsening pathway, the SoP imposes an additional constraint: clinical worsening applies only to material contribution to, or aggravation of, Barrett oesophagus where the Barrett oesophagus was suffered or contracted before or during relevant service and did not arise out of the relevant service (s 10(2)). That means claimants whose condition both arose out of service and was first acquired in service fall outside the clinical‑worsening mode described in s 10(2).

Right to rely on other SoPs for cross‑referenced factors. If a factor in s 9 refers to an injury or disease covered by another SoP, the claimant may rely on the factors in that other SoP as they are in force from time to time (s 11). That gives claimants the right to be assessed under the up‑to‑date terms of any cross‑referenced SoP.

Right to the defined clinical meaning. The SoP sets the operative clinical meaning of Barrett oesophagus for claims under this instrument (s 7(2)). Claimants and decision makers must use that textual definition even though an ICD‑10‑AM code is acknowledged (s 7(3)). In claims work, this affords a stable textual standard albeit one that requires clinical proof.

Duty to consider death caused or contributed to by Barrett oesophagus. The SoP brings death within scope where a terminal event or condition was contributed to by Barrett oesophagus (s 7(4)). The Schedule specifies which terminal events are included, giving claimants and decision makers a concrete list of proximate causes that may be treated as death from Barrett oesophagus for the purpose of the SoP (Schedule 1).

No express procedural rights or express duty to provide medical records. The instrument does not itself create a duty on any particular agency to gather records or an express right on the claimant to require particular process. Those procedural duties and rights will be derived from the VEA and MRCA provisions that govern claims; this SoP is the medical causation input that those processes must apply where relevant (s 3-5).

The Statement of Principles instrument contains no penal provisions, administrative fines, or criminal sanctions. It is a medical‑causation determination instrument and, as drafted, functions as a substantive standard to be applied to claims under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. Its operation is to provide the medical nexus criteria decision makers should apply; the instrument does not itself prescribe enforcement mechanisms or penalty regimes.

Authority and application. The legal authority for the SoP is subsection 196B(3) of the VEA, which the instrument cites as the head of power under which the Repatriation Medical Authority made the instrument (s 3). The instrument applies to claims falling under s 120B of the VEA or s 339 of the MRCA (s 5). Any enforcement, dispute resolution or review mechanisms that arise in relation to adverse or favourable claim decisions will flow from those Acts and their administrative frameworks rather than from this SoP itself. The instrument does not detail how decision makers must record, notify, or review determinations that use the SoP.

No internal sanctioning for non‑compliance. The instrument does not specify consequences for failing to meet a listed factor. The practical effect is that if a claimant cannot establish at least one of the factors in s 9, or cannot show the factor is related to relevant service as required by s 10(1), the claimant will not meet the standard set out in this SoP for causation on the balance of probabilities. The statutory or administrative consequences of that failure, such as claim denial or entitlement refusal, arise under the VEA and MRCA processes referenced in s 5, not under the SoP itself.

Decision maker discretion and evidentiary weight. The SoP states the Repatriation Medical Authority’s view on causation based on the available medical evidence (s 8). It sets out what the Authority considers sufficient medical factors to meet causation on the balance of probabilities. The instrument does not remove decision maker discretion to evaluate the particularities of evidence in individual cases, but where the listed factors are established and related to service, the SoP provides the Authority’s prescriptive causation framework for those decision makers to apply.

Interplay with other legal remedies. The instrument does not describe appeal rights, review bodies, or remedies. Any rights to administrative review or judicial review of decisions that apply the SoP will derive from the procedural provisions of the VEA and MRCA and associated administrative law, none of which are incorporated into or described by this instrument. The SoP’s role is evidentiary and definitional, not enforcement oriented.

The instrument situates itself within the VEA/MRCA statutory architecture by reference rather than by restatement of the procedural law. The explicit interactions are: authority, application, repeal of a prior SoP, cross‑reference to other SoPs, and reliance on ICD‑10‑AM coding for identification but not for definition.

Statutory authority and application. The SoP is made under subsection 196B(3) of the Veterans' Entitlements Act 1986 (s 3). It applies to claims to which section 120B of the VEA or section 339 of the MRCA applies (s 5). The instrument therefore functions as a medical pronouncement designed to be used within the statutory claims frameworks established by those provisions of the VEA and MRCA. The instrument does not reproduce the operative provisions of those Acts, nor does it specify the administrative steps by which claims are lodged, assessed, or reviewed.

Repeal of earlier SoP. The instrument expressly repeals the earlier Statement of Principles concerning Barrett’s oesophagus (No. 68 of 2016) as recorded on the Federal Register of Legislation (s 4). Mechanically, that repeal replaces the earlier medical causation statement with the updated criteria contained in this instrument. Any ongoing claims assessments that previously relied on the 2016 SoP must now apply the 2025 SoP for claims to which the application clause applies.

Interaction with other SoPs. Section 11 governs inter‑SoP interaction. If a factor in section 9 refers to an injury or disease that is the subject of another SoP made under subsection 196B(3) of the VEA, then the factors set out in that other SoP apply “in accordance with the terms of that Statement of Principles as in force from time to time” (s 11(1)-(2)). That is a dynamic cross‑reference. It means that when a listed factor is materially the same as or refers to another defined disease, the decision maker must use the other SoP’s current factors to determine whether that cross‑referenced factor is established. In practice, this creates an ongoing dependency: updates to related SoPs can alter how those cross‑referenced factors are evaluated in Barrett oesophagus claims.

ICD‑10‑AM coding. The instrument refers to ICD‑10‑AM code K22.7 as the code generally associated with Barrett oesophagus, but it makes clear that the definition for the SoP is the textual definition in subsection 7(2) (s 7(2)-(3)). The instrument also specifies the edition and effective date of the ICD‑10‑AM referenced (Tenth Edition, effective date 1 July 2017) and cites the copyright owner. That means the ICD code is an identification aid, but the statutory definitional content is the textual metaplasia description in s 7(2).

Dependence on Schedule definitions. The SoP’s operation relies on the Schedule 1 dictionary, which defines “relevant service”, “terminal event”, MRCA, and VEA (Schedule 1). That linkage determines which classes of service are within scope and which terminal events will be treated as deaths that may be contributed to by Barrett oesophagus when assessing fatality claims under the SoP.

No express interaction with non‑referenced federal or state laws. The instrument does not attempt to harmonise or displace other Commonwealth, state or territory statutes outside the VEA and MRCA references, nor does it refer to administrative procedural laws. Its effect is limited to providing the medical causation criteria that will feed into decisions made under the cited provisions of the VEA and MRCA.

This instrument contains its own immediate amendment record and a repeal of the prior Statement of Principles in the same subject area. The key documented steps in the instrument are the repeal of the earlier SoP and the commencement date.

Repeal of prior Statement of Principles. Section 4 expressly repeals the Statement of Principles concerning Barrett’s oesophagus (Balance of Probabilities) (No. 68 of 2016) as recorded on the Federal Register of Legislation under reference F2016L01137. The effect is that the 2016 instrument is no longer in force and is replaced by this instrument for claims to which the application clause applies.

Commencement. The instrument indicates its commencement date as 24 November 2025 (s 2). The instrument is dated 24 October 2025, and the commencement date is about one month later, giving a built‑in period between the instrument’s making and its legal commencement (front matter and s 2).

Authority under the VEA. The instrument records that it was made under subsection 196B(3) of the VEA (s 3). That is the statutory source of authority for that instrument’s creation and for subsequent amendments made in the same statutory manner.

No other amendments recorded within the document. The instrument does not record any incremental amendments, variations, or transitional provisions beyond repeal of the 2016 SoP and its own commencement date. The instrument does not record savings or transitional rules for claims lodged before commencement. It likewise does not state whether claims filed before commencement are to be assessed under the old or new SoP; that point is not addressed within this instrument.

Dynamic interaction with other SoPs. Section 11 creates an ongoing amendment linkage in practice because it makes the application of cross‑referenced factors depend on the “terms of that Statement of Principles as in force from time to time” (s 11). That means that while this instrument itself may remain unchanged, factors incorporated by reference from other SoPs may change over time if those other SoPs are amended. Practitioners should note that an amendment to a different SoP that is cross‑referenced could change how a factor in this SoP is evaluated, even though this instrument might be static.

No internal amendment procedure or timetable supplied. The instrument does not set out how or when it might be amended in future. It was made by the Repatriation Medical Authority under the cited statutory power, but the document does not include a schedule for future review or an exposition of the triggers for amendment. The only explicit historical amendment recorded inside the instrument is the repeal of the 2016 SoP.

The instrument does not include any case references, dispute outcomes or judicial decisions. It contains no record of litigation either challenging, interpreting or applying this particular Statement of Principles. The text of the instrument does, however, identify the legal basis on which it is made and the standard of proof it adopts.

Absence of recorded cases or precedents. Nowhere in the instrument are cases cited, nor are prior tribunal or court decisions referenced. The SoP states the Repatriation Medical Authority’s view based on “sound medical‑scientific evidence” but the document does not reproduce or attach that evidence, nor does it cite adjudicative decisions that applied SoPs in similar contexts (s 8).

Implications for users. Given the instrument’s silence on litigation, practitioners should treat the SoP as an authoritative medical causation statement made by the Repatriation Medical Authority for use in claims under the specified provisions of the VEA and MRCA (s 3-5, s 8-9). Any legal challenges or judicial review proceedings that may arise from decisions applying this SoP would be addressed through the procedural avenues available under the VEA or MRCA or through administrative law channels, but the instrument does not annotate or summarise such avenues.

No transitional litigation record. The instrument repeals the earlier 2016 SoP but does not record any litigation arising from that repeal or from the transition between the two SoPs (s 4). The document is silent on whether disputes about claims lodged before the commencement date will be determined using the prior or current SoP. That subject is left to the underlying statutory claims processes and is not addressed in the instrument.

Evidentiary basis not reproduced. Section 8 asserts the Authority’s view is founded on “sound medical‑scientific evidence,” but the instrument does not include a bibliography, explanatory memorandum, or compendium of the studies and reports relied upon. The absence of that material in the instrument means there is no direct evidentiary record inside the text to which litigants or reviewers can point; any litigation would have to engage with external medical evidence or administrative records not included in the instrument itself.

This instrument is compact and precise, but several points in the text present practical traps and potential sources of dispute for claimants and practitioners. Each of these “gotchas” follows directly from the instrument’s wording and the definitional or temporal constraints the SoP imposes.

Balance of probabilities wording. The title and s 8 frame the causation standard as “more probable than not.” While that is the standard the Authority used to determine the SoP, the instrument does not restate how that standard interfaces with adjudicative burdens of proof under the VEA or MRCA. Practitioners should note that the SoP identifies factors that the Authority considers sufficient on that standard, but the instrument itself does not set out who bears the overall evidentiary burden within the claims procedure.

At least one factor must exist. The instrument is explicit that at least one of the factors in s 9 must exist before a finding of connection can be made (introductory text to s 9). A common error might be assuming a multiplicity of lesser indicators could substitute for a listed factor. The SoP does not create such a composite option; it requires at least one listed factor, established in the required terms.

Temporal thresholds and the phrase “clinical onset or clinical worsening.” Many factors are qualified by a duration and by relation to “clinical onset or clinical worsening” (s 9(1)-(3) and note). The instrument does not define “clinical onset” or “clinical worsening.” That leaves room for variable clinical interpretation and potential contest about the relevant onset or worsening dates. The burden of establishing those dates will be on the claimant within the claims process that applies the SoP.

BMI and waist circumference measurement periods. The obesity‑related factor requires either BMI ≥30 or a waist circumference exceeding 102 centimetres for males or 88 centimetres for females, and these conditions must exist for at least five years immediately preceding clinical onset or clinical worsening (s 9(3)). The SoP specifies the BMI calculation formula (note to s 9) but does not specify whether interim fluctuations, measurement method, or retrospective self‑reported weights are acceptable evidence. Absence of contemporaneous, documented measures for the required five‑year period may weaken a claimant’s ability to rely on this factor.

“Before clinical onset or clinical worsening.” Several factors require the condition to exist before clinical onset or clinical worsening (s 9(1), s 9(2), s 9(4), s 9(5)). For clinical worsening claims, s 10(2) further restricts application to cases where Barrett oesophagus was suffered or contracted before or during relevant service and did not arise out of the service. Practitioners should be alert to the narrowness of this path: if Barrett oesophagus arose out of service, clinical worsening as described in s 10(2) will not operate to establish the service connection in the same way.

“Unable to obtain appropriate clinical management” is undefined. Section 9(6) lists inability to obtain appropriate clinical management before clinical worsening as a qualifying factor, but the instrument does not define “appropriate clinical management” nor specify what evidence satisfies inability to obtain it. That phrase is a potential locus of administrative discretion and dispute. Claimants will need to document attempts to obtain care and the reasons why care was not available or appropriate under contemporaneous circumstances.

Cross‑referencing to other SoPs can move the goal posts. Section 11 imports factors from other SoPs “as in force from time to time.” That makes the application of cross‑referenced factors dynamic. A factor that relies on another SoP’s definition may be affected by amendments to that other SoP. Practitioners must check the current version of any cross‑referenced SoP at the time of assessment.

ICD code versus textual definition. The SoP notes the ICD‑10‑AM code K22.7 for Barrett oesophagus but states the meaning for this SoP is the definition in subsection 7(2) (s 7(2)-(3)). It would be a mistake to rely solely on an ICD‑10‑AM coding entry in a medical record without showing the clinical morphologic change that the textual definition requires.

Narrow definition of “relevant service.” The Schedule’s definition of “relevant service” excludes several service categories by express phrasing (Schedule 1). Practitioners must check whether the claimant’s service type falls within the definitions in the Schedule before engaging with the SoP; otherwise, the SoP will not apply to the claim.

No guidance on evidentiary sufficiency. The SoP sets out the qualifying factors and durations but does not prescribe documentary standards, acceptable types of evidence, or thresholds of proof within the claims process. What constitutes sufficient proof of a two‑year history of GORD, a five‑year period of obesity, or inability to obtain care is left to the claims processes under the VEA and MRCA. That is a gap that practitioners must navigate through gathering contemporaneous records and persuasive clinical reports.

Death causation and “terminal event” list. The SoP includes deaths where Barrett oesophagus contributed to a terminal event and provides a list of terminal events in the Schedule (Schedule 1). However, there is an evidentiary challenge in showing contribution to such an event rather than sole causation. The SoP does not offer a method for apportioning contribution; that is a matter for clinical evidence in each claim.

Compliance with this Statement of Principles means assembling and presenting the evidence necessary to establish, on the balance of probabilities, that Barrett oesophagus or death from Barrett oesophagus is connected with the claimant’s relevant service by reference to at least one of the factors in section 9 and the relationship rules in section 10. Below are concrete, source‑grounded steps and evidence types that the instrument makes central.

1. Identify whether the SoP applies to the claim. Confirm that the claim falls under section 120B of the VEA or section 339 of the MRCA as required by s 5. Check that the claimant’s service is one of the “relevant service” categories in the Schedule: eligible war service other than operational service, defence service other than hazardous service or British nuclear test defence service under the VEA, or peacetime service under the MRCA (Schedule 1).

2. Establish the diagnosis of Barrett oesophagus using the SoP’s definition. Present clinical evidence demonstrating metaplasia of the lower oesophageal epithelium from stratified squamous to columnar epithelium, including any endoscopy and histopathology reports. Although the SoP recognises ICD‑10‑AM code K22.7, rely on the textual definition in subsection 7(2) as the operative meaning for the SoP (s 7(2)-(3)).

3. For fatality claims, document contribution to a terminal event. If asserting death from Barrett oesophagus, obtain the death certificate, clinical summaries, autopsy or coroner’s findings, and treating clinicians’ opinions that Barrett oesophagus contributed to a terminal event listed in Schedule 1, such as pneumonia or respiratory failure (s 7(4); Schedule 1).

4. Demonstrate at least one qualifying factor in s 9. For each factor, collect the specific evidence the SoP demands:

   • Gastro‑oesophageal reflux disease for at least two years before clinical onset or clinical worsening: obtain medical records, prescriptions (eg proton pump inhibitor use), specialist letters, endoscopy reports or diagnostic codes that show a GORD history for at least two years immediately prior to the relevant onset/worsening date (s 9(1)).
   • Hiatus hernia before onset/worsening: obtain imaging or endoscopy reports confirming hiatus hernia with dates that predate clinical onset or worsening (s 9(2)).
   • Obesity measures for at least five years immediately preceding onset/worsening: secure contemporaneous weight/height records to calculate BMI = W/H2 using the formula in the note; alternatively, record repeated waist circumference measurements showing >102 cm for males or >88 cm for females as required for the five‑year period (s 9(3) and BMI note).
   • Systemic sclerosis (scleroderma) diagnosed before onset/worsening: obtain rheumatology records or other specialist diagnostic documentation showing systemic sclerosis predating the onset/worsening (s 9(4) and note).
   • Inability to obtain appropriate clinical management before clinical worsening: collect evidence of attempts to access care, referrals, wait lists, or letters indicating treatment unavailable or inappropriate in the relevant period prior to clinical worsening (s 9(6)). Because “appropriate clinical management” is not defined in the instrument, contemporaneous records and treating clinician opinions will be important.

5. Demonstrate the timing of clinical onset or clinical worsening. The instrument ties factor durations to “clinical onset or clinical worsening.” Prepare a clear chronology, supported by clinical notes, specialist assessments and diagnostic reports, to identify the date of clinical onset and any documented date(s) of clinical worsening.

6. Show the relation to relevant service. Section 10 requires that any factor relied upon be related to the person’s relevant service. Provide service records, medical treatment records from service time, and clinical opinions linking the factor to service. For claims relying on clinical worsening, ensure the Barrett oesophagus was suffered or contracted before or during service and did not arise out of the service if relying on the aggravation pathway described in s 10(2).

7. Where a factor refers to another Statement of Principles, check that other SoP. If a factor in s 9 references a disease or injury that itself is covered by another SoP, obtain and apply the current terms of that other SoP, as these apply “as in force from time to time” (s 11). Practitioners must verify the most recent version of any cross‑referenced SoP to ensure compliance.

8. Prepare expert clinical opinion. Because the SoP is evidence‑driven and uses clinical thresholds and timing, obtain contemporaneous treating records and, where necessary, independent specialist reports that address diagnosis, chronology, duration of conditions, measurements for BMI or waist circumference, and causation or contribution opinions linking listed factors to service.

9. Address potential evidentiary gaps proactively. Anticipate gaps such as absent five‑year BMI records or missing documentation of inability to obtain management. Where contemporaneous records do not exist, consider compiling a chain of medical evidence including tertiary clinical opinion, allied health records, pharmacy dispensing histories and any service medical logs that can substantiate the required durations and link to service.

10. Document the provenance of any ICD coding. While the SoP requires the textual definition in s 7(2) as controlling, ICD‑10‑AM coding may accompany records. Where ICD codes are used in medical files, ensure clinicians tie the coding to the morphological description required by s 7(2).

11. Keep the SoP context current. Because s 11 imports cross‑referenced factors from other SoPs “as in force from time to time,” review the current versions of any such SoPs at the time of claim preparation and prior to hearing or review. Also note the repeal of the 2016 SoP and ensure no legacy reliance on the prior text remains in the claim materials (s 4).

12. Use the SoP dates and definitions precisely. Observe the instrument’s commencement date (24 November 2025, s 2) and the textual definitions in Schedule 1 for terms such as “relevant service,” “terminal event,” MRCA and VEA. These definitions determine whether the SoP applies and how death is treated for the purpose of the claim.

By assembling specific documentary proof for the factor relied upon, a clear chronology for onset or worsening, service records evidencing the relationship with relevant service, and specialist medical opinion that ties the clinical facts to the SoP’s criteria, practitioners can present claims that align with the instrument’s stated requirements. The SoP does not prescribe procedural forms or the precise evidentiary quantum beyond the listed factors and durations, so compliance requires careful documentary and clinical preparation tailored to the instrument’s textual thresholds.