Statement of Principles concerning bruxism (Reasonable Hypothesis) (No. 7 of 2026)

The central legal concept is the "reasonable hypothesis" connecting a medical condition to relevant service. The instrument operationalises that evidentiary concept by prescribing that at least one enumerated factor must exist before a reasonable hypothesis can be said to have been raised (s9). The listed factors are concrete clinical events, diagnoses, exposures, and behavioural patterns measured at the time of clinical onset or clinical worsening.

Key definitional concepts:

• Bruxism. The instrument defines bruxism as a disorder of jaw muscle activity characterised by repetitive, involuntary clenching or grinding of the teeth, or bracing or thrusting of the mandible, during wakefulness or sleep (s7(2)). The instrument notes the commonly used ICD‑10‑AM codes (G47.63 or F45.8), but stresses that the legal meaning is the statutory definition in s7(2) (s7(3)-(4)).
• Death from bruxism. Death is within scope where a terminal event or condition was contributed to by the person’s bruxism (s7(5)). The Schedule defines "terminal event" by listing proximate or ultimate causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (Schedule 1, terminal event).
• Relevant service. The instrument applies to persons who rendered "relevant service" as defined in Schedule 1. That definition incorporates specified categories under both the VEA and the MRCA: operational service, peacekeeping service, hazardous service and British nuclear test defence service under the VEA, and warlike and non‑warlike service under the MRCA (Schedule 1, relevant service).
• Clinically significant qualifiers. Two recurring qualifiers appear: "clinically significant disorder of mental health" and "clinically significant neurological condition as specified" (Schedule 1). The former is defined as a disorder warranting ongoing management, with the explicit note that absence of actual management does not preclude the condition (Schedule 1, clinically significant disorder of mental health, note). The latter is a closed list of neurological conditions (cerebrovascular accident, craniocervical dystonia, Huntington’s chorea, multiple sclerosis, Parkinson disease and secondary parkinsonism, subarachnoid haemorrhage, subdural haematoma) (Schedule 1).
• Temporal and relational qualifiers. Factors must be present "at the time of the clinical onset or clinical worsening" (s9). The instrument distinguishes between onset and clinical worsening; the latter is limited in application where bruxism preceded or was contracted during service but did not arise out of service (s10(2)).

The instrument structures causation analysis by substituting specified factual showings for a more general medico‑legal causation inquiry. Where a claimant can demonstrate the existence of at least one enumerated factor connected to relevant service, the RMA considers the reasonable hypothesis threshold to be met (s8-9). The cross‑reference rule in s11 links this instrument to other Statements of Principles when a factor itself denotes an injury or disease governed elsewhere, thereby allocating responsibility for the evidential content to the other instrument as it stands from time to time (s11).

This instrument affects persons making claims under provisions specified in the legislation and the administrative decision‑makers and clinicians involved in assessing those claims. The instrument declares that it "applies to a claim to which section 120A of the VEA or section 338 of the MRCA applies" (s5). In practice the categories of persons within that scope are those who have rendered "relevant service" as defined in Schedule 1: operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike or non‑warlike service under the MRCA (Schedule 1, relevant service).

Who bears the evidential tasks and consequential burdens:

• Claimants. Individuals who assert a service connection for bruxism or death from bruxism must rely on this Statement of Principles for the causation element of their claim. The instrument sets out the factual showings that will be treated by the RMA as sufficient to raise a reasonable hypothesis (s9). Claimants therefore must provide evidence that an enumerated factor existed at the relevant time and that the factor is related to the person's relevant service (s10(1)). For death claims, petitioners must show that bruxism contributed to the terminal event or condition causing death (s7(5)).
• Decision‑makers and medical assessors. The RMA has enacted the instrument and states it is of the view that sound medical‑scientific evidence supports the list of factors (s8). Administrators and medical officers assessing claims will use the instrument as the RMA’s authoritative position on which factors will raise a reasonable hypothesis. The RMA’s lists therefore direct medical causation assessments in the veterans’ entitlements and MRCA regimes, subject to any applicable legislative standards of proof and procedures outside this instrument.
• Healthcare providers and record‑keepers. The factors listed require clinical evidence, for example diagnosis of a clinically significant neurological condition or a disorder of mental health, medication histories, documentation of traumatic brain injury, and records showing alcohol and caffeine consumption patterns. The Schedule contains particular definitional rules that affect evidential content, for example that a clinically significant disorder of mental health is one that warrants ongoing management and that actual management is not required (Schedule 1).
• Other Statement of Principles. Where a listed factor refers to an injury or disease covered by another Statement of Principles determined under subsection 196B(2) of the VEA, the terms of that other Statement apply "as in force from time to time" (s11). This means claimants and decision‑makers may need to consult additional RMA instruments to establish the fact and timing of that underlying factor.

Persons who do not render relevant service are outside the instrument’s statutory reach; the instrument is expressly tied to the VEA and MRCA claim pathways (s5). The instrument itself creates no penalties or direct private rights; rather it defines the causal link tests for those participating in the veterans’ entitlements and MRCA systems (see s3, s5, s8).

This Statement of Principles primarily governs evidential assessments rather than prescribing procedural duties or conferring discrete new rights. The RMA’s duty to set these principles arises from the enabling provision (subsection 196B(2) of the VEA), and it exercises that power by issuing this instrument (s3). From the claimant and administrative perspective the key operational duties and rights are as follows.

Rights and entitlements established or engaged by the instrument:

• Right to rely on the Statement for causation. A person making a claim under the specified sections of the VEA or MRCA may rely on this Statement as the RMA’s determination of the factors that raise a reasonable hypothesis that bruxism or death from bruxism is related to relevant service (s5, s8-9). The instrument specifies the set of factors which, if present and related to service, the RMA considers sufficient to meet the reasonable hypothesis threshold (s9).
• Right to have factors cross‑referenced. If a listed factor is itself an injury or disease covered by another RMA Statement of Principles, then the terms of that other Statement apply in determining that factor (s11). This is a right in the sense that the claimant can invoke the other Statement’s terms as part of the causation showing.

Duties and evidential obligations that follow from the instrument:

• Duty to establish existence of a factor at time of clinical onset or worsening. The instrument makes timing central. Claimants bear the factual obligation of establishing that at least one of the enumerated factors existed at the time of clinical onset or clinical worsening (s9).
• Duty to link the factor to relevant service. Section 10(1) requires that the existence of any factor in section 9 "must be related to the relevant service rendered by the person." This imposes an additional relational element beyond mere existence of the factor.
• Duty to respect the limits on the clinical worsening pathway. Section 10(2) confines the application of the clinical worsening aspect of factors to cases where the person’s bruxism was suffered or contracted before or during, but did not arise out of, relevant service. In other words, the clinical worsening route is not available where the bruxism arose out of service; the claimant must navigate which pathway applies and adduce the right evidence.

Notable definitional rights and duties embedded in the Schedule:

• Clinically significant disorder of mental health. The instrument defines this as warranting ongoing management and explicitly provides that lack of actual management does not defeat the label (Schedule 1). The consequence is that claimants need not prove that the mental health condition was treated to rely on it as a factor, but they must show it meets the "warrant ongoing management" threshold.
• Use of ICD‑10‑AM codes. The instrument references ICD‑10‑AM codes for labelling but insists the statutory definition of bruxism controls (s7(3)-(4)). Practitioners must therefore focus on the statutory description rather than mere coding.

What the instrument does not do:

• It does not create procedural duties such as time limits, review mechanisms, evidentiary rules, or appeal rights; those are governed by the VEA, MRCA and associated procedural law. The Statement is an RMA medical instrument purposed to guide causation assessments (s3, s5, s8).
• It does not specify standards of proof or burden of proof in the claims process; it speaks to when a reasonable hypothesis is raised through specified factors (s8-9).

In summary, the principal operational duty created by the Statement is for claimants to prove the existence at the relevant time of at least one enumerated factor and to show its relationship to the person's relevant service (s9-10). The principal right is the ability to rely on these enumerated factors as meeting the RMA’s threshold for a reasonable hypothesis in claims covered by s120A VEA or s338 MRCA (s5, s8-9).

The Statement of Principles itself contains no penalty provisions and does not prescribe enforcement mechanisms. The instrument is an administrative medical instrument rather than a punitive measure: it sets out the factors the Repatriation Medical Authority considers sufficient to raise a reasonable hypothesis that bruxism or death from bruxism is related to relevant service (s8-9). It does not create criminal offences, civil penalties, or administrative fines, and it does not specify enforcement processes within the text provided.

Enforcement, insofar as the Statement affects outcomes, operates indirectly through the claims processes under the VEA and MRCA. The instrument applies to claims under section 120A of the VEA and section 338 of the MRCA (s5). Those statutes and their administrative frameworks will set the procedural, review and sanction mechanisms for claims generally. The Statement will inform decision‑makers applying those statutes on causation matters; the practical "enforcement" effect is that adjudicators will treat the presence of a listed factor, if related to relevant service, as raising a reasonable hypothesis of service connection (s9-10). Consequences that may follow in adjudicative terms include acceptance of service connection and the attendant administrative outcomes within the VEA/MRCA regimes. Those consequences are outcomes of the broader statutory schemes, not penalties specified by this instrument.

Because the Statement cross‑refers to other Statements of Principles where a factor refers to another injury or disease, the RMA’s instruments operate as an integrated set of medical‑causation standards (s11). The absence of penalty provisions in the instrument should be treated literally: compliance or non‑compliance with the Statement’s criteria affects eligibility determinations and benefit outcomes through existing decision‑making pathways, rather than triggering bespoke sanctions enacted by this Statement.

Practical enforcement and review risks:

• Administrative reliance. The efficacy of the Statement in practice depends on administrative decision‑makers and medical assessors adopting the RMA’s view in their adjudication. The instrument itself does not bind courts, but within the administrative ecosystem the RMA’s Statements are the statutory source for causation guidance (s3, s8).
• Dynamic reference to other Statements. Section 11 makes the application of some factors contingent on other Statements of Principles "as in force from time to time." That creates an enforcement complexity: a factor’s governing content may change with amendments to another Statement, and decision‑makers must track updated instruments to ensure they apply the correct terms (s11).

In short, the Statement is not an enforcement instrument in the penal sense. Its operational enforcement effect lies in shaping evidential thresholds used by decision‑makers in the VEA and MRCA systems. The instrument itself imposes no fines, sanctions or criminal liabilities.

The instrument is expressly tied to the statutory claims regimes under the VEA and MRCA. The text makes multiple cross‑references which define its legal relationships:

• Application to statutory claim pathways. The instrument applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (s5). That means the Statement is part of the evidence framework used in those statutory regimes to assess causation; practitioners must therefore read it in conjunction with the substantive and procedural rules in the VEA and the MRCA.
• Authority under the VEA. The instrument is made under subsection 196B(2) of the VEA (s3). Its legal force as an RMA determination stems from that statutory power. The instrument’s status and scope are thus determined by the enabling provision and the wider VEA framework.
• Cross‑reference to other Statements of Principles. Section 11 provides that if a factor in section 9 refers to an injury or disease that is the subject of another Statement of Principles made under subsection 196B(2) of the VEA, then "the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time" (s11). This creates an operational link: some factual showings for bruxism claims may require referential consultation of other RMA Statements, and those Statements, as amended, govern the content of the referenced factor.
• Medical coding and classification. The instrument references ICD‑10‑AM codes (s7(3)-(4)). It states that while bruxism attracts ICD‑10‑AM codes G47.63 or F45.8, the meaning for the Statement is the statutory definition in s7(2). The reference to a specific edition of ICD‑10‑AM (Tenth Edition, effective date 1 July 2017) may affect how medical records coded under that system are interpreted for causation, though the instrument emphasises the statutory definition controls (s7(3)-(4)).
• Definitions that intersect other medical conditions. The Schedule lists specific neurological conditions and defines "clinically significant disorder of mental health" (Schedule 1). Some of those conditions may be independently the subject of other RMA Statements, which triggers the s11 cross‑reference.
• Precedence over earlier RMA instrument. The instrument expressly repeals the prior Statement of Principles concerning bruxism (No. 91 of 2016) (s4). Practitioners must therefore use this document rather than the 2016 Statement for claims arising on or after its commencement. The repeal effect indicates an update in the RMA’s medical view and legal instrument set.
• Interaction with medical evidence and clinical practice. The instrument ties legal determinations to clinical concepts such as "clinical onset", "clinical worsening", medication use, sustained substance use, and inability to obtain appropriate clinical management (s9). This binds the administrative causation inquiry to clinical timings and records, thus intersecting with health privacy, medical record disclosure regimes and the evidentiary practices of clinicians,although those statutory privacy and evidence regimes are outside the text of this instrument.

Caveats in interaction:

• The Statement does not itself modify or override the substantive entitlements, procedures, standards of review, or appeals processes in the VEA or MRCA. Those remain governed by their respective statutes and associated regulations. The Statement functions as a medical‑causation input into those processes.
• The dynamic cross‑reference in s11 means that changes to other Statements will affect how certain factors are applied to bruxism claims. Decision‑makers must therefore monitor the corpus of RMA instruments.

Overall, the instrument fits into an administrative legal ecosystem where RMA Statements provide standardised medical causation criteria and must be applied alongside the substantive and procedural law of the VEA and MRCA.

The instrument contains its own minimal amendment history information. It expressly repeals the earlier Statement of Principles concerning bruxism (Reasonable Hypothesis) (No. 91 of 2016) (Federal Register of Legislation No. F2016L01672) (s4). The current instrument is dated 19 December 2025 and commences 19 January 2026 (s2, front matter). Those are the only temporal and amendment markers contained in the text.

What the repeal and remake mean operationally:

• Repeal of the 2016 Statement. The instrument replaces the 2016 Statement. Practitioners must treat the 2016 instrument as no longer operative for claims within the statutory application of this instrument. The text does not reproduce the 2016 instrument or describe how the tests have changed; it only states the prior instrument is repealed (s4).
• Effective dates. The instrument’s effective operation begins on its commencement date, 19 January 2026 (s2). The date on which the RMA executed the instrument is 19 December 2025 (front matter). Claims and assessments to which the instrument applies from commencement forward will be governed by its terms.
• Dynamic interplay with other Statements. Section 11’s reference to other Statements "as in force from time to time" introduces a dynamic amendment pathway. Even though this particular instrument sets a fixed set of factors as at its commencement, factors that are themselves governed by other Statements may change operationally if those other Statements are amended. The instrument thus embeds an ongoing connection to future amendments of other RMA instruments.

No other amendments, savings provisions, transitional arrangements, or sunset clauses are contained in the text. The instrument does not specify whether any claims in progress at commencement are to be assessed under the old or new Statement. Practitioners must therefore consult the VEA and MRCA administrative guidance or decision makers for transitional application, since the instrument itself does not address those questions.

The instrument itself contains no litigation history and does not reference any court or tribunal decisions. The text names no cases and records no challenges, judicial reviews, or appellate decisions relating to this Statement. The only historical instrument mentioned is the prior Statement repealed by this instrument (No. 91 of 2016) (s4); no litigation in relation to that earlier instrument is cited.

Practical consequences of the absence of litigation references:

• No judicially crystallised interpretations. Because the instrument contains no litigation history, there are no judicially developed interpretive guides embedded in the text. Decision‑makers and practitioners will be guided exclusively by the statutory language of this Statement and by the legislative frameworks of the VEA and MRCA unless and until courts or tribunals consider the Statement in contested proceedings.
• Potential for future litigation on constructional issues. The instrument contains terms that may give rise to interpretive disputes in administration and litigation, for example the meaning of "related to the relevant service" (s10(1)), the scope of "clinical onset or clinical worsening" (s9), what constitutes "inability to obtain appropriate clinical management" (s9(k)), and how to apply the cross‑reference in s11. Each of these could be the subject of future legal argument, but the instrument itself records no such litigation.
• Dependence on administrative practice. In the short term practitioners must rely on administrative application of the Statement by decision‑makers and any internal guidance, rather than on judicial interpretation.

Until such time as courts or tribunals have considered and articulated principles of interpretation for this instrument, its meaning will be determined by its text, the Schedule definitions, and the way administrative decision‑makers apply it in the VEA and MRCA claims processes.

The instrument contains several drafting features and definitional choices that can produce practical traps if not carefully attended to. These are points practitioners and claimants frequently overlook if they read only superficially.

1. Reasonable hypothesis represented by discrete enumerated factors. The Statement does not adopt an open causation test. Instead a claimant must establish at least one of the listed factors at the time of clinical onset or clinical worsening to raise a reasonable hypothesis (s9). Absent evidence of a listed factor, the Statement will not, by itself, support a finding that a reasonable hypothesis exists.

2. Timing is central. Every factor in section 9 must be present "at the time of the clinical onset or clinical worsening" (s9). Practitioners must distinguish between pre‑onset exposures and the relevant timing. Clinical records must show the timing of onset or documented worsening relative to the listed factor.

3. Relationship to relevant service. The Statement does not permit factors to be asserted in isolation; section 10(1) requires the existence of any factor in section 9 to be "related to the relevant service rendered by the person." That relational element is separate from showing the factor exists. Evidence must connect the factor to the person’s relevant service. The instrument does not specify examples of acceptable proof of that relation; practitioners must assemble evidence connecting the factor and service.

4. Narrow application of clinical worsening pathway. Section 10(2) restricts the clinical worsening aspect of the factors so it applies only to material contribution to, or aggravation of, bruxism where the bruxism was suffered or contracted before or during, but did not arise out of, relevant service. The phrase "did not arise out of" is a limiting condition. If bruxism "arose out of" the relevant service, then the clinical worsening pathway is not the route contemplated by s10(2). Practitioners must decide whether a case is one in which bruxism arose out of service or pre‑existed/did not arise out of service; the evidential strategy differs accordingly.

5. Clinically significant mental health condition does not require treatment. The instrument defines a "clinically significant disorder of mental health" as a disorder warranting ongoing management and specifies that actual management need not have occurred (Schedule 1, clinically significant disorder of mental health). This is counterintuitive. Claimants may thus rely on untreated but sufficiently severe mental health disorders, provided they can show they met the "warrant ongoing management" threshold.

6. Specified medication and substance lists. Section 9(d) lists particular medications and classes whose use at the time of clinical onset or worsening is a factor: amphetamines and derivatives including methamphetamine and MDMA, antipsychotics, cocaine, dexamphetamine, flunarizine, levodopa, methylphenidate, SSRIs, and SNRIs (s9(d)). Practitioners must attend to both the specific named substances and the class‑based entries. Documentation must show contemporaneous use at onset or worsening.

7. Quantitative thresholds for alcohol and caffeine. The instrument specifies consumption thresholds: at least 30 grams of alcohol per day for a continuous 6 months prior to onset or worsening (s9(e)), calculated using the Australian Standard of 10 grams per standard drink (note to s9), and at least 6 cups of caffeinated coffee per day daily during the 6 months before onset or worsening (s9(f)). These precise quantitative thresholds create evidentiary demands on claimants to document sustained consumption patterns; anecdotal or vague evidence may not suffice.

8. "Inability to obtain appropriate clinical management" as a factor. The instrument recognises that lack of access to appropriate clinical management before clinical worsening is a factor (s9(k)). The instrument does not define "appropriate clinical management" or specify the causal nexus required between lack of management and subsequent worsening. That leaves room for administrative debate about what constitutes appropriate management and what evidence will suffice to prove inability to obtain it.

9. Cross‑reference to other Statements. If a factor in s9 refers to an injury or disease that is also the subject of another RMA Statement, that other Statement's factors apply "as in force from time to time" (s11). Practitioners therefore must check the current version of other Statements to understand the content and timing of the referred factor. Failure to do so may mean reliance on outdated or repealed provisions.

10. ICD‑10‑AM codes are referenced but not determinative. Although the instrument notes that bruxism attracts certain ICD‑10‑AM codes, it makes plain that the statutory meaning is the s7(2) description (s7(2)-(4)). Relying on coding alone without satisfying the statutory description is a potential pitfall.

11. Death claims require contribution to a terminal event. For death claims, bruxism must have contributed to the terminal event or condition that caused death (s7(5)). The Schedule defines a range of terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). Documenting contribution as opposed to mere co‑existence will be essential.

12. No transitional guidance is provided. The instrument repeals the prior Statement but contains no transitional provisions or guidance on claims in progress (s4). Practitioners should not assume transitional rules; administrative guidance may be required from the agencies administering the VEA and MRCA.

In sum, the main gotchas are temporal proof, relational proof to relevant service, the limited scope of the clinical worsening pathway, quantitative thresholds for substance use, and the dynamic cross‑reference to other Statements. Each of these creates discrete evidentiary tasks that need targeted documentation.

For claimants, advocates and advisers preparing bruxism or death from bruxism claims under the VEA or MRCA, compliance with this Statement of Principles requires a focussed evidentiary strategy tied to the instrument’s language. The following steps are derived from the instrument’s requirements and definitions.

1. Establish a diagnosis of bruxism per the statutory meaning. Begin by documenting a clinical diagnosis that matches the instrument’s definition: repetitive, involuntary clenching or grinding of the teeth, or bracing or thrusting of the mandible, occurring during wakefulness or sleep (s7(2)). While ICD‑10‑AM codes G47.63 or F45.8 may appear in records, the primary task is to show the clinical features set out in s7(2) rather than relying on code alone (s7(3)-(4)).

2. Identify and prove at least one enumerated factor at the relevant time. The Statement requires that "at least one of the following factors must as a minimum exist" to raise a reasonable hypothesis (s9). For each asserted factor, assemble contemporaneous or retrospective medical records, medication histories, toxicology where relevant, and credible witness evidence as applicable. Key factor evidentiary needs include:

   • Traumatic brain injury. If claiming a moderate to severe traumatic brain injury within the 30 days before clinical onset or worsening, obtain neurology, emergency department, imaging reports and hospital records showing the injury, its severity and dates relative to onset or worsening (s9(a)).
   • Neurological conditions. For any of the listed clinically significant neurological conditions (cerebrovascular accident, craniocervical dystonia, Huntington’s chorea, multiple sclerosis, Parkinson disease and secondary Parkinsonism, subarachnoid haemorrhage, subdural haematoma), obtain diagnostic reports, specialist notes and any investigation results and show the condition was present at the time of clinical onset or worsening (Schedule 1; s9(b)).
   • Mental health disorders. For anxiety disorder, depressive disorder, or posttraumatic stress disorder claimed under s9(c), compile psychiatric assessments, GP records, psychological reports, and any indicators that the disorder met the threshold of "warrant ongoing management." Remember that the absence of actual management does not defeat the claim; evidence must nonetheless show clinical severity warranting ongoing management (Schedule 1 note; s9(c)).
   • Medication and substance use. For the listed drugs and classes, provide prescription records, pharmacy dispensing data, hospital medication charts, toxicology reports or clinician notes that evidence use at the time of onset or worsening (s9(d)). For alcohol, document sustained consumption at or above 30 grams per day for six continuous months prior to onset/worsening, using drink records, clinical notes, or corroborating evidence; apply the Australian 10 gram per standard drink standard as the calculation basis (s9(e) and note). For caffeine, obtain records or statements supporting an average of at least six cups of caffeinated coffee per day during the six months prior to onset/worsening (s9(f)).
   • Gastro‑oesophageal reflux disease. Provide endoscopy reports, GP or specialist notes and diagnostic test results showing a diagnosis of GORD at the time of onset/worsening (s9(g)).
   • Inability to obtain appropriate clinical management. This factor requires evidence that appropriate management was not available or accessible prior to clinical worsening. Collect referral records, appointment histories showing unsuccessful attempts to obtain care, correspondence with health providers, and contextual evidence showing barriers to access. The Statement does not define "appropriate clinical management," so provide objective evidence of standard-of-care management unavailable in the circumstances (s9(k)).

3. Prove the factor was related to relevant service. Section 10(1) requires that the factor(s) relied upon be related to the relevant service rendered by the person. Evidence may include service records, incident reports, deployment medical records, contemporaneous service medical entries, and any documentation linking service events or exposures to the factor. The Statement does not prescribe a specific form of evidence for the relational element, so combine clinical and service documentation to build the causal relationship (s10(1)).

4. For clinical worsening claims, apply the limited pathway correctly. If relying on clinical worsening rather than initial onset, note section 10(2): the clinical worsening aspect of the factors applies only to material contribution to, or aggravation of, bruxism where the person’s bruxism was suffered or contracted before or during, but did not arise out of, the person’s relevant service. Establish that bruxism pre‑existed or was contracted during service and that it did not arise out of service, then show how the factor materially contributed to or aggravated the condition (s10(2)).

5. For death claims, demonstrate contribution to the terminal event. When the claim concerns death from bruxism, obtain cause of death certificates, coronial findings if any, medical records proximate to death, and expert opinions linking bruxism to the terminal event or condition listed in the Schedule. The Schedule lists terminal events such as pneumonia and respiratory failure; show medical causation that bruxism contributed to one of those terminal events (s7(5); Schedule 1, terminal event).

6. Check cross‑references to other Statements. If the factor relied upon is itself an injury or disease covered by another RMA Statement, obtain and apply the terms of that other Statement "as in force from time to time" (s11). This requires checking current RMA instruments to ensure the factual content and timing requirements for the referred factor are met.

7. Use precise temporal documentation. The instrument focuses on "the time of the clinical onset or clinical worsening." Therefore, establish the dates of onset and/or documented worsening in medical records, and link the presence of the factor to those dates.

8. Prepare medico‑legal or specialist opinions where necessary. For complex causal links, for example where bruxism is said to have materially contributed to a terminal event or where a neurological condition is contested, retain specialists or medico‑legal experts to provide opinion evidence that ties the clinical facts to the instrument’s criteria.

9. Expect administrative reliance on the instrument. Decision‑makers will treat the RMA’s Statement as authoritative on the listed factors and their sufficiency to raise a reasonable hypothesis (s8-9). Tailor evidence to the instrument’s specific language rather than to generic causation arguments.

10. Monitor for amendments to other Statements. Because s11 imports other Statements "as in force from time to time," maintain an up‑to‑date check on RMA instruments that may alter the content of any referred‑to factor.

By following these steps, claimants and advisers will align their evidentiary packages with the precise requirements of the Statement. The focus should be on contemporaneous clinical documentation, clear timing evidence, linkage to relevant service records, and fulfillment of any quantitative thresholds set out in the instrument.