For claimants, clinicians, legal advisers and administrative decision‑makers, compliance means building an evidentiary package that aligns with the precise factors and definitions in the instrument and showing the nexus to “relevant service” as defined in the Schedule.
Step 1 , Establish statutory diagnosis: Map the claimant’s clinical diagnosis to the statutory definition in subsection 7(2). Confirm the anatomical site is one of the included sites (conjunctiva, cornea, retina, choroid, ciliary body, lacrimal gland, lacrimal duct, orbit) and that it is not one of the explicit exclusions (subsection 7(2)(2)). Do not rely solely on ICD‑10‑AM coding: the instrument states its own definition governs (section 7(3)).
Step 2 , Choose the applicable factor(s): There are only two qualifying factors (section 9). Determine whether the claim will rely on the HPV factor (section 9(1)), or on inability to obtain appropriate clinical management (section 9(2)), or both. Remember the management factor has the additional constraint in subsection 10(2) that it applies only where the benign neoplasm was suffered or contracted before or during, but did not arise out of, relevant service.
Step 3 , Gather medical and laboratory evidence tailored to the factor:
- For the HPV factor (section 9(1)): obtain virology/histopathology reports that identify HPV infection of the conjunctival epithelium and, crucially, demonstrate the strain and timing. Evidence should show one of the enumerated strains (5b, 6, 6a, 11, 13, 16, 18, 20, 31, 33 or 45) was present and that the infection existed prior to clinical onset of conjunctival papilloma. Serial test results, pathology reports with strain typing, and contemporaneous clinical records are the most direct evidence.
- For the clinical management factor (section 9(2) and section 10(2)): assemble contemporaneous clinical notes, referral letters, specialist appointment records, waitlist evidence, correspondence with health services, or policy documents showing that appropriate management was not available or was denied prior to clinical worsening. Also collect objective documentation of the clinical worsening (e.g. serial visual acuity measures, lesion progression on imaging or clinical photographs, histological progression). Because subsection 10(2) requires that the condition was suffered or contracted before or during, but did not arise out of, relevant service, show medical records establishing the pre‑existence and timing relative to service.
Step 4 , Link factor(s) to relevant service: The instrument requires the factor relied upon to be related to relevant service (section 10(1)). Use service records, deployment history, medical records during service, contemporaneous reports and any evidence showing how service circumstances caused, contributed to or aggravated the factor. For the management factor, demonstrate how service conditions or the service health system caused the inability to obtain appropriate care, and how that inability materially contributed to or aggravated the condition.
Step 5 , Address death claims: If the claim is for death from the condition, obtain cause of death documentation and show how benign neoplasm of the eye and adnexa contributed to the terminal event or condition identified in Schedule 1 as a “terminal event” (Schedule 1). Provide medical evidence linking the neoplasm to the proximate or ultimate cause of death.
Step 6 , Consider cross‑reference Statements: Review section 11. If any factor relied upon refers to another injury or disease covered by a different RMA Statement, obtain evidence that the other Statement requires and apply that Statement’s factors. Failure to identify a cross‑reference may lead to incomplete evidence.
Step 7 , Prepare legal submissions that reconcile undefined terms: Because the Statement does not define “persistent infection”, “appropriate clinical management” or “clinical worsening”, submissions should explain the medical standards relied upon and cite contemporaneous evidence showing the claimant’s situation met those clinical standards. For example, explain what “persistence” means for HPV in the conjunctiva in the claimant’s case and produce serial virology/pathology to match.
Step 8 , Use the fixed ICD edition for administrative cross‑checking: For administrative coding and record extraction, use the ICD‑10‑AM Tenth Edition referenced in the instrument (section 7(4)) to locate relevant hospital and health records. Then ensure those records are reconciled with the statutory definition in subsection 7(2).
Step 9 , Anticipate and document temporal gaps: Because causation analysis often hinges on timing, ensure that dates of infection detection, onset of clinical signs, dates of service and timing of attempted clinical management are precisely documented. Where contemporaneous testing is lacking, obtain retrospective expert opinion explaining the likely chronology and how the available tests and clinical history support the required temporal relationships.
Step 10 , Prepare for decision‑maker interpretation and potential review: Given undefined terms and discretionary assessment, clearly articulate the factual basis for each element in written submissions. If a decision goes against the claimant, document the evidentiary deficiencies and be prepared to pursue internal review or statutory avenues under the VEA/MRCA if applicable; the Statement itself does not set review procedures but will be the basis on which administrative decisions are assessed.
Following these steps aligns evidence and submissions to the instrument’s precise wording and the Schedule’s definitions, thereby reducing the risk that claims will be rejected for failing to meet the narrow factors the RMA has specified.