Statement of Principles concerning blepharitis (Reasonable Hypothesis) (No. 29 of 2019)

This instrument is a Statement of Principles (SOP) made under subsection 196B(2) of the Veterans' Entitlements Act 1986 (VEA). It determines that blepharitis , including chalazion (Meibomian cyst) and hordeolum (stye) , and death from blepharitis can be related to relevant service rendered by veterans, Peacekeeping Force members, or Forces members under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (MRCA), provided a reasonable hypothesis can be raised. The SOP specifies 33 factors, at least one of which must exist before such a hypothesis can be said to be raised. The instrument repeals and replaces the earlier Statement of Principles concerning blepharitis No. 63 of 2010.

Mechanically, the SOP does two things. First, it defines the condition: blepharitis means inflammation of the eyelid margins or glands of the eyelid, explicitly including acute and chronic blepharitis, chalazion, and hordeolum, and explicitly excluding orbital or periorbital cellulitis, dacryoadenitis, and dacryocystitis. Second, it lists factors that, if present, can connect the condition to service. The factors are divided into two groups: those relevant to the clinical onset of blepharitis (factors 1 to 17) and those relevant to clinical worsening (factors 18 to 33). Many factors appear in both groups, but some , such as smallpox immunisation within two weeks before onset (factor 4) and taking oral isotretinoin or acitretin for at least one year before onset (factor 17) , apply only to onset. Conversely, factor 33 , inability to obtain appropriate clinical management for blepharitis , applies only to worsening.

The SOP applies to claims to which section 120A of the VEA or section 338 of the MRCA applies. It operates within a statutory framework that relaxes the standard of proof for service-related conditions. Under the reasonable hypothesis standard, the decision-maker does not need to be satisfied on the balance of probabilities; rather, the claimant must point to material that raises a hypothesis connecting the condition to service, and the SOP sets the minimum medical-scientific factors that must be present for such a hypothesis to exist.

The instrument itself does not create any legal rights or obligations for private parties. It binds the Repatriation Commission and other decision-makers in determining claims. It is a legislative instrument made by the Repatriation Medical Authority, which must be of the view that there is sound medical-scientific evidence that the condition can be related to relevant service. The basis for the factors is stated in section 8: the Authority is of that view. The reasons for that view are not disclosed in the instrument, but the instrument itself is the authorised statement of the factors.

The central concept is the "reasonable hypothesis". In the veterans' compensation context, this is a lower evidentiary threshold than the normal civil standard. Section 120A of the VEA requires that the Repatriation Medical Authority determine SOPs about particular kinds of injury, disease, or death, and that those SOPs set out the factors that must exist before a reasonable hypothesis can be raised. This SOP determines those factors for blepharitis. The hypothesis must be reasonable in the sense that it is not contrary to proven medical science or obviously fanciful. The SOP's factors are drawn from sound medical-scientific evidence, as stated in section 8.

A key distinction in the SOP is between clinical onset and clinical worsening. Clinical onset refers to the first appearance of the condition. Clinical worsening refers to a material increase in severity or symptoms after the condition has already manifested. Factors 1 to 17 apply to clinical onset; factors 18 to 33 apply to clinical worsening. Importantly, for worsening factors, section 10(2) provides that they apply only to material contribution to, or aggravation of, blepharitis where the person's blepharitis was suffered or contracted before or during (but did not arise out of) the person's relevant service. This means a veteran who already had blepharitis before service cannot claim that service caused the condition, but can claim that service aggravated it if one of the worsening factors is present.

The SOP defines blepharitis broadly. It covers acute and chronic forms, and includes chalazion (Meibomian cyst) and hordeolum (stye). It excludes orbital or periorbital cellulitis, dacryoadenitis, and dacryocystitis. Death from blepharitis includes death from a terminal event such as pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function, if the blepharitis contributed to that event.

The dictionary (Schedule 1) contains important definitions that narrow or expand the scope of factors. For example, "infection of the affected eyelid" means a bacterial, viral, or fungal infection involving the skin, hair follicles, or glands of the eyelid. Not all infections count; it must be of the affected eyelid specifically. "Allergen" means an antigenic substance capable of producing an immune response leading to allergic contact dermatitis , not just any allergen. "Irritant substance" means a chemical which causes an inflammatory effect on living tissue by chemical action at the site of contact, leading to irritant contact dermatitis. These definitions are legally operative and could be decisive in claim determinations.

The SOP directly affects any person who has rendered "relevant service" and who makes a claim for compensation under the VEA or MRCA in respect of blepharitis, or a dependant claiming in respect of death from blepharitis. This includes veterans who served in operational, peacekeeping, hazardous, or British nuclear test defence service (under the VEA), and members who rendered warlike or non-warlike service under the MRCA. It does not cover peacetime service that is not classified under those categories, nor does it cover civilians who are not veterans.

Indirectly, the SOP affects the Repatriation Commission, which assesses claims, and the Veterans' Review Board and Administrative Appeals Tribunal, which review decisions. Legal practitioners, claims advocates, and medical practitioners who provide evidence in support of claims must understand the SOP's factors to frame their submissions. The SOP is also relevant to those who advise veterans on the likelihood of a successful claim.

The SOP does not impose any duties or obligations on private medical practitioners or hospitals. It does not regulate clinical practice. However, it creates incentives for claimants to seek medical evidence that addresses the specific factors listed. For example, a veteran with blepharitis who also has diabetes mellitus or rosacea will have a stronger claim precisely because those conditions are listed as factors. Conversely, a veteran whose blepharitis is idiopathic may find it difficult to meet any factor.

Because the SOP applies a reasonable hypothesis standard, the evidentiary burden on the claimant is lower than in ordinary civil litigation. But the claimant must still point to material that supports the existence of at least one factor related to service. This shifts the practical cost onto the government, which bears the administrative and adjudicative costs of assessing claims. The cost of the SOP itself - the potential for successful claims - is borne by taxpayers through the compensation system. The SOP does not constrain the number of claims; it only sets the medical-scientific gate for those claims.

The SOP creates no direct duties or rights for individuals. It is a legislative instrument that binds the decision-maker. Under section 120A of the VEA, the Repatriation Commission must not make a determination that a condition is service-related unless the SOP has been complied with. The Commission's duty is to apply the SOP when assessing whether a reasonable hypothesis exists. If the claimant raises at least one factor that is supported by material, and that factor is related to service, the Commission must accept that a reasonable hypothesis exists unless there is a contrary indication that disproves the hypothesis beyond reasonable doubt.

The claimant has a right to have their claim assessed in accordance with the SOP. If the Commission fails to apply the SOP correctly, the claimant can seek review. The claimant also has a right to submit material that addresses any of the factors. There is no obligation on the claimant to prove the factor on the balance of probabilities; the material need only point to the factor's existence. This is a significant concession.

The SOP does not confer any private right to sue. It does not create a cause of action. It is purely an evidentiary instrument within the administrative compensation framework. The only "right" it creates is a rebuttable presumption in favour of the claimant if the factors are satisfied.

For medical practitioners, there is no legal duty to provide evidence in a particular way, but in practice, claims are strengthened when medical reports explicitly refer to the relevant factor (e.g., "the veteran had rosacea at the time of clinical onset of blepharitis"). The SOP thus shapes the evidence that advocates and practitioners produce.

The SOP itself contains no penalties. It is not a penal instrument. Penalties for false or misleading statements in connection with a claim arise under the VEA, not under this SOP. Section 139 of the VEA makes it an offence to knowingly make a false statement in a claim, punishable by imprisonment. The SOP does not alter or expand that regime.

Enforcement of the SOP is administrative. The Repatriation Commission and the Veterans' Review Board enforce its application by reviewing claims and decisions. If the Commission misapplies the SOP, the VRB can set aside the decision and substitute a correct one. The AAT can also review decisions. Judicial review by the Federal Court is available on limited grounds.

The SOP does not impose any compliance burden on anyone other than the decision-maker. There is no registration, reporting, or auditing obligation. The only "cost" of the SOP is the administrative cost of processing claims that would otherwise be rejected. That cost is borne by the government and, ultimately, taxpayers. The SOP also creates an opportunity cost: resources spent processing claims for blepharitis could be spent on other claims.

The SOP operates under the VEA and MRCA. It is made under subsection 196B(2) of the VEA and applies to claims under section 120A of the VEA and section 338 of the MRCA. Those provisions require that a claim cannot be determined to be service-related unless the SOP has been complied with. Thus, the SOP is not merely advisory; it is a mandatory evidentiary gate.

Section 11 of the SOP explicitly provides for interaction with other SOPs. If a factor refers to an injury or disease for which another SOP has been determined under subsection 196B(2) of the VEA, then the factors in that other SOP apply. For example, factor 15 refers to having diabetes mellitus at the time of clinical onset of blepharitis. Diabetes mellitus is itself a condition for which an SOP exists. To rely on factor 15, the claimant must also satisfy the diabetes mellitus SOP in relation to their diabetes. This creates a chain of causation: the diabetes must be service-related (or at least raise a reasonable hypothesis under its own SOP) before it can serve as a factor for blepharitis. This cascading approach increases the evidentiary burden on claimants who rely on secondary conditions.

The SOP also interacts with the definition of "relevant service" in the VEA and MRCA. Only service that falls within that definition gives rise to the application of the SOP. Service that does not qualify cannot be used as a basis for a claim that relies on this SOP.

The SOP repeals the earlier 2010 SOP on blepharitis (No. 63 of 2010). That repeal means any claim determined after 25 March 2019 must be assessed under the new factors. The old factors no longer apply. This is important for transitional claims or for claims that were lodged but not determined before commencement.

There is no direct interaction with the common law, tort law, or workers' compensation schemes. The SOP is solely within the veterans' compensation framework. It does not affect private insurance contracts or clinical guidelines.

This SOP, No. 29 of 2019, was made on 1 March 2019 and commenced on 25 March 2019. It repealed and replaced the Statement of Principles concerning blepharitis No. 63 of 2010, which was made under the same authority. The source document contains no information about any amendments or variations made to this SOP after its commencement. The instrument appears to be the current version as at its making. Any subsequent amendments would be published separately on the Federal Register of Legislation. The SOP states that it is made under subsection 196B(2) of the VEA, which is the "reasonable hypothesis" limb. There is a separate "balance of probabilities" SOP for the same condition (usually made under subsection 196B(3) or (13)), but that is not this instrument.

The repeal of the 2010 SOP means that any factors that were in the old SOP but are absent from the new one no longer apply. Conversely, new factors (such as the inclusion of rosacea, psoriasis, discoid lupus erythematosus, dry eye disease, and the specified list of parasites) have been added. The removal of old factors and addition of new ones reflects the Repatriation Medical Authority's assessment of the evolving medical-scientific evidence as at 2019.

The source document does not refer to any litigation. The instrument itself has not, on its face, been the subject of judicial consideration. Statements of Principles are reviewable by the Administrative Appeals Tribunal and the Federal Court, but no specific cases are noted. It is possible that the earlier 2010 SOP was the subject of litigation, but the source does not provide that information. The current SOP's litigation history would involve any challenge to the validity of the factors or the Authority's decision not to include additional factors. Such challenges are rare and require showing that the Authority acted without power or failed to consider relevant material. No such litigation is referenced here.

Several features of this SOP could trip up an unwary advocate or decision-maker.

First, the distinction between clinical onset and clinical worsening is critical. Factor 33 (inability to obtain appropriate clinical management) applies only to worsening, not onset. A claimant who never had blepharitis before service but develops it during service will not be assisted by factor 33. Conversely, a claimant whose blepharitis existed before service cannot rely on the onset factors; they must use the worsening factors (18-33) and satisfy section 10(2) that the condition was contracted before or during (but not arising out of) service.

Second, the definitions in the dictionary are narrow and technical. "Infection of the affected eyelid" is limited to bacterial, viral, or fungal infection of the eyelid skin, hair follicles, or glands. A generalised infection elsewhere in the body will not suffice. "Allergen" and "irritant substance" both require the development of contact dermatitis , not just any allergic or irritant reaction. This means that non-dermatitic reactions (e.g., simple conjunctivitis) may not qualify.

Third, the smallpox immunisation factor (factor 4) applies only to clinical onset, and only within two weeks before onset. Given smallpox vaccination is no longer routine, this factor is largely historical but could be relevant for older veterans.

Fourth, the immunocompromised state definition includes "chronic renal failure" as a sub-condition. Chronic renal failure itself is defined in the dictionary, but that definition appears somewhat oddly placed: it defines chronic renal failure at length even though it is only used in the definition of immunocompromised state. This is not a substantive trap, but it could cause confusion if someone assumes chronic renal failure is a standalone factor , it is not.

Fifth, factor 17 requires taking oral isotretinoin or oral acitretin for a continuous period of at least one year before the clinical onset, and if treatment ceased, onset must occur within 30 days of cessation. This is a specific temporal requirement that must be strictly proven. A shorter course or cessation more than 30 days before onset will not suffice.

Sixth, the SOP incorporates other SOPs by reference under section 11. This means that to prove a factor such as diabetes mellitus or seborrhoeic dermatitis, the claimant must also satisfy the relevant SOP for that condition. If the diabetes SOP requires a different set of factors, the claimant must meet those as well. The overall burden is cumulative.

Seventh, the SOP applies only to claims under section 120A VEA or section 338 MRCA. It does not apply to claims under the Safety, Rehabilitation and Compensation Act 1988 or the Defence Force Retirement and Death Benefits Act 1973. Practitioners must ensure the correct compensation scheme is being used.

Compliance with this SOP is a matter for decision-makers and for claimants presenting their case. There is no proactive compliance obligation. For a claimant, the pathway is straightforward in concept but demanding in evidence.

The first step is to obtain a diagnosis of blepharitis as defined , that is, inflammation of the eyelid margins or glands, not orbital cellulitis, dacryoadenitis, or dacryocystitis. The diagnosis should be supported by clinical notes or specialist report. The next step is to identify which of the 33 factors may apply. This requires a detailed medical and service history. For example, if the claimant has rosacea of the periocular region, that is factor 6 (onset) or factor 22 (worsening). The claimant must have contemporaneous medical evidence showing rosacea at the time of clinical onset or worsening.

For each factor, the claimant must establish that it is related to their relevant service. For example, if the factor is having an infection of the affected eyelid, the infection must have occurred during service or be attributable to service. If the factor is having diabetes mellitus, the diabetes must itself be service-related under its own SOP.

The claimant or their advocate should prepare a written submission that identifies the specific factor(s) relied upon, with citations to medical records. The submission should explain how the factor existed at the relevant time (clinical onset or worsening). For worsening, the submission must also address that the blepharitis existed before or during service but did not arise out of service, and that the factor materially contributed to its worsening.

If the factor is another condition covered by an SOP (e.g., seborrhoeic dermatitis), the advocate must also address that condition's SOP. This may require obtaining a separate diagnosis and establishing the factors for that condition.

For decision-makers, compliance means applying the SOP strictly. The decision-maker must first determine whether blepharitis as defined exists. Then, they must consider each factor and whether the material raises a reasonable hypothesis. They must not impose a balance-of-probabilities test. They must also consider section 10(2) for worsening claims.

The practical burden of compliance falls on the claimant, who must gather and present the evidence. This can be costly in terms of medical reports and legal advice. The SOP does not require any third-party compliance. There is no registration, notification, or reporting requirement. The only penalty for non-compliance is that the claim may be rejected, which is an adverse outcome for the claimant, not a penal sanction.