Statement of Principles concerning cardiac myxoma (Balance of Probabilities) (No. 84 of 2025)

The instrument crystallises several core concepts that an assessor or advocate must treat as definitional when dealing with cardiac myxoma claims under the VEA and MRCA.

Definition of cardiac myxoma: Section 7(2) provides the operative medical definition for the instrument: a benign neoplasm of the heart composed of primitive connective tissue cells and stroma resembling mesenchyme. The instrument expressly states that, although cardiac myxoma typically has ICD‑10‑AM code D15.1, the statutory meaning is the textual definition in subsection 7(2) rather than the code alone (sections 7(3)-(4)). This places the text of the instrument ahead of coding labels when assessing scope.

Death from cardiac myxoma: Section 7(5) imports death into the coverage by reference to a “terminal event or condition that was contributed to by the person's cardiac myxoma.” The Schedule 1 definition of “terminal event” lists explicit proximate/ultimate causes (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). Thus a death certificate listing one of those terminal events may still fall within the instrument if the assessor finds that the terminal event was contributed to by cardiac myxoma.

Relevant service: The Schedule 1 defines “relevant service” for the purposes of the instrument as 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. Thus the instrument applies to discrete, defined categories of service (Schedule 1).

Probative factors: Section 9 sets out the required factual circumstances, at least one of which must exist for the condition or death to be connected to service on the balance of probabilities. The three factors are: (1) having a heart transplant before clinical onset; (2) having blunt force trauma to the chest immediately preceding clinical worsening; and (3) inability to obtain appropriate clinical management for cardiac myxoma before clinical worsening. The instrument adds a clinical note about embolisation following blunt chest trauma (s9 note), which explains the medical mechanism that underpins factor (2).

Relationship and timing: Section 10 requires that any factor that exists must be related to the person’s relevant service. Subsection 10(2) clarifies that the “clinical worsening” aspect of the factors applies to material contribution to, or aggravation of, cardiac myxoma where the person’s cardiac myxoma was suffered or contracted before or during (but did not arise out of) the person’s relevant service. This creates a temporal and causation rule distinguishing conditions that arose during service from those present before service.

Interaction with other Statements of Principles: Section 11 provides a mechanism for cross‑reference: if a factor in s9 refers to an injury or disease already covered by another Statement of Principles, then the factors in that other Statement apply in accordance with its terms. This embeds a networked approach to evidentiary criteria and means that assessors must consult other SOPs where cross‑referenced conditions are implicated.

Authority and evidentiary standard: Section 8 records the Authority’s view that the causal connection exists on the balance of probabilities based on medical‑scientific evidence. The instrument is titled “Balance of Probabilities,” which signals the civil standard applied in entitlement assessments under the VEA and MRCA.

Terminology and coding: The instrument both uses and overrides ICD‑10‑AM coding for statutory purposes (s7(3)-(4)), and the Schedule defines key terms like “terminal event,” MRCA and VEA. Practitioners should therefore treat the textual definitions in the instrument as authoritative in preference to external coding where there is any mismatch.

Collectively, these concepts establish what must be proved, how death is treated, the relevant service categories, and how cross‑referenced conditions and timing issues are to be handled in claims involving cardiac myxoma.

Primary affected persons: The instrument applies to persons making claims under the VEA or MRCA where section 120B of the VEA or section 339 of the MRCA are engaged (section 5). The Schedule defines “relevant service,” so the primary class affected is veterans or members of the Forces whose service falls within eligible war service (excluding operational service), defence service (excluding hazardous service and British nuclear test defence service) under the VEA, or peacetime service under the MRCA (Schedule 1).

Decision‑makers: The Repatriation Medical Authority is the issuing body (section 3). Administratively, the SOP will be used by decision‑makers operating under the VEA and MRCA , for example, the Department administering VEA/MRCA claims and medical panel assessors , although the instrument itself does not list the administrative actors. The instrument alters the evidentiary framework those decision‑makers use in determining whether cardiac myxoma or death from cardiac myxoma is “connected with the circumstances of the person’s relevant service” on the balance of probabilities (sections 8-10).

Medical practitioners and hospitals: The way the Statement frames “clinical onset,” “clinical worsening,” and “inability to obtain appropriate clinical management” affects how treating clinicians’ notes, surgical reports (for heart transplant), imaging, records of trauma, and records of attempted or failed referral/treatment will be assessed. The instrument’s reference to a heart transplant before clinical onset (section 9(1)) and the note on blunt force trauma leading to embolisation (s9 note) directly implicates cardiac surgeons, emergency physicians, and trauma teams in the evidentiary chain for claims.

Families and estates: Because death from cardiac myxoma is within scope when a terminal event was contributed to by myxoma (section 7(5)), next of kin, executors and legal representatives pursuing deceased veterans’ entitlement claims will need to engage with the instrument’s definitions and factors. The Schedule definition of “terminal event” provides specific causes of death that will be considered.

Insurers and third parties: The instrument does not alter private insurance contracts, but by defining the evidentiary criteria for statutory entitlements it can affect the behaviour and valuation of claims that overlap private coverage. The SOP does not, however, create new monetary liabilities outside the VEA/MRCA scheme itself (sections 3 and 5).

Cross‑referenced SOP regimes: Section 11 provides that if a factor in section 9 refers to an injury or disease covered by another Statement of Principles, the factors in that other Statement apply. That affects claimants and assessors by requiring consultation of multiple SOPs where factors invoke other conditions.

In sum, this instrument primarily affects veterans and members whose service fits the Schedule 1 definition of “relevant service,” the medical and administrative professionals who create and assess the clinical record for entitlement decisions under the VEA and MRCA, and representatives acting for claimants or deceased estates. The required evidentiary link between a listed factor and relevant service (section 10) creates a discrete burden on claimants to show that a factor is related to their service.

This instrument is not framed as conferring duties in the criminal or regulatory sense; rather it prescribes the factual criteria and definitional rules that bear on entitlement determinations under the VEA and MRCA. The operative “duties” and “rights” arise in three respects: (1) the Authority’s duty to issue Statements under the VEA statutory mechanism, (2) claimant rights to have claims assessed under the set evidentiary rules, and (3) the obligations on assessors to apply the Statement when relevant.

Authority’s statutory function: The instrument is made under subsection 196B(3) of the VEA (section 3). That is the statutory basis for the Repatriation Medical Authority to publish Statements establishing factors and relationships for particular injuries or diseases. The text records the Authority’s medical‑scientific view (section 8); the Authority, in exercising its delegated function, has set the evidentiary framework that decision‑makers are to apply in VEA/MRCA claims concerning cardiac myxoma.

Claimant’s evidentiary right to the balance of probabilities: The instrument is expressed in terms of the civil standard, “Balance of Probabilities,” and states that at least one of the factors in section 9 must exist before connection to service can be said to be established on the balance of probabilities (section 9). Claimants therefore have the right to have their condition or death assessed against the criteria in this Statement. The Statement also embeds the requirement that any factor must be related to relevant service (section 10(1)), so claimants have the right to challenge or support a decision by adducing evidence linking a listed factor to their relevant service period.

Assessor obligations to apply the Statement: Where a claim falls within the application clause (section 5), decision‑makers and medical assessors are obliged to apply the Statement’s definitions and factors as part of the decision process under the VEA or MRCA. Section 11 requires that, when a factor in section 9 refers to an injury or disease covered by another Statement of Principles, the factors in that other Statement apply in accordance with its terms. This creates an obligation on assessors to consult cross‑referenced Statements and apply them as directed.

Documentary and clinical requirements implicit in the instrument: The specific factors translate into discrete evidentiary points that claimants must establish. For example, the first factor is “having a heart transplant before clinical onset” (section 9(1)). That creates a right of the claimant to rely on clinical records of transplant date and clinical onset records; equally, the decision-maker is entitled to expect and require such records to determine whether the factor exists. The second factor is “blunt force trauma to the chest immediately preceding clinical worsening” (section 9(2)); this converts traumatic history and temporal sequencing into key facts to be proven. The third factor is “inability to obtain appropriate clinical management for cardiac myxoma before clinical worsening” (section 9(3)), which makes access and availability of treatment part of the evidentiary case.

Limitations: The Statement does not create an independent duty on third parties to provide care, nor does it specify administrative remedies or compensation levels , those are governed by the VEA and MRCA statutory schemes into which this Statement fits (see sections 3 and 5). The Statement’s function is limited to setting presumptive/matters for establishing connection according to the balance of probabilities standard, not to prescribing benefits or levels of payment itself.

In short, the key operative rights are claimants’ entitlement to assessment against the Statement’s factors and definitions, and the corresponding duty on assessors to apply these rules and to consult cross‑referenced SOPs where applicable.

This Statement of Principles contains no penal provisions and does not itself create enforceable criminal or civil penalties. The instrument is an evidentiary, medical‑scientific instrument designed to guide entitlement decisions under the VEA and the MRCA; it is not framed as a regulatory code that imposes fines, sanctions, or direct enforcement mechanisms.

Statutory context for enforcement: The instrument is made under subsection 196B(3) of the VEA (section 3) and applies to claims under section 120B of the VEA and section 339 of the MRCA (section 5). Enforcement, penalties or remedies for wrongful claims, non‑compliance, or administrative errors,if any,are governed by the parent statutes (VEA and MRCA) and their administrative processes, not by this Statement. The Statement’s role is to define the factual criteria that decision‑makers should use in applying those statutes.

Administrative consequence flow: In practice, the Statement will influence administrative decisions about whether a person’s cardiac myxoma or death from cardiac myxoma is connected with relevant service on the balance of probabilities (sections 8-10). A negative finding under the Statement’s criteria can mean that entitlement under the VEA or MRCA is not established; any procedural consequences (denial of benefits, reassessment, internal review, or merits review) derive from the parent legislation and administrative practice associated with claims under those Acts. The instrument itself does not specify appeal routes, limitation periods, or enforcement procedures.

Evidentiary effect: The Statement determines what factors “must exist” (section 9) and how they relate to service (section 10). Where a decision-maker applies the Statement and finds the criteria unsatisfied, the practical enforcement effect is that the claim will not be accepted as connected to service under the relevant statutory test. Any administrative sanctions for misrepresentation or fraud would likewise depend on the VEA/MRCA and related administrative and criminal law, not on the Statement.

Cross‑referenced Statements: Section 11 directs that, where a factor refers to an injury or disease covered by another Statement, the factors in that other Statement apply. That creates a chain of evidentiary rules across Statements, but it does not add independent enforcement mechanisms beyond those in the relevant statutory schemes.

Recordkeeping and evidentiary reliance: Because the Statement makes the existence of specific factors determinative for connection on the balance of probabilities, there is an implied requirement that decision‑makers and claimants maintain and produce clinical, surgical, or incident records to support or refute the factors. Failure to produce records may adversely affect a claimant’s case, but again, that is an evidentiary and administrative consequence, not a statutory penalty contained within the instrument.

In sum, the Statement prescribes the evidentiary framework for establishing connection to service, but it does not itself create penalties or enforcement mechanisms; those remain situated in the VEA and MRCA and the administrative apparatus that implements them.

Primary statutory footing: The Statement is produced under subsection 196B(3) of the Veterans' Entitlements Act 1986 (VEA) (section 3). It expressly applies to claims to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 (MRCA) applies (section 5). Therefore its operative function is as a medical‑evidentiary input into determinations made under those Acts. Any legal effects, remedies, benefits or processes beyond the Statement itself are governed by the VEA, the MRCA and their administrative frameworks.

Reference to ICD‑10‑AM: The instrument notes that cardiac myxoma attracts ICD‑10‑AM code D15.1 but clarifies that for applying the Statement the statutory definition in subsection 7(2) is the relevant meaning (sections 7(3)-(4)). The Statement therefore interacts with the international classification system by reference, but the textual definition in the instrument is controlling for statutory purposes. Assessors should therefore treat the instrument’s wording as authoritative even where ICD coding might suggest a different boundary.

Cross‑reference to other Statements of Principles: Section 11 sets a direct interaction rule: where a factor in section 9 refers to an injury or disease covered by another Statement of Principles made under subsection 196B(3) 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.” This creates an explicit dependency network among Statements; practitioners must therefore identify whether a factor invokes another SOP, and then apply that other SOP’s factors as current at the time of decision. This mechanism integrates the cardiac myxoma Statement into a broader statutory matrix of SOPs.

Relation to VEA/MRCA decision processes: Because the Statement applies to claims under specific sections of the parent Acts (section 5), it becomes an evidentiary instrument that influences statutory determinations of entitlement under the VEA and MRCA. The instrument does not modify those Acts’ substantive benefit rules, thresholds for compensation, or procedural regimes; rather it provides medical criteria for establishing causal connection to service. Any contest about the application or interpretation of this Statement in the course of a statutory decision will be resolved within the dispute resolution and review mechanisms provided by the VEA and MRCA frameworks.

Temporal and definitional interactions: The Schedule defines “relevant service” and “terminal event,” which constrains the universe of service types and causes of death that interact with the Statement. Thus, a claimant’s service must fall within the Schedule’s categories to trigger the Statement’s application. Similarly, a death listed under the Schedule’s terminal event list may still fall within scope if the assessor finds that cardiac myxoma contributed to that terminal event (section 7(5) and Schedule).

No direct interaction with criminal or regulatory law: The Statement does not purport to create or alter criminal liabilities, occupational health and safety obligations, or private law obligations; it is narrowly designed to feed into statutory entitlement determinations under the VEA and MRCA. Any interactions with other areas of law (for example, workers’ compensation, civil damages or private insurance) are indirect and factual: the Statement’s findings may be relevant evidence in other contexts but do not themselves create rights or liabilities outside the VEA/MRCA frameworks.

Effect of repeal: The express repeal of the earlier No. 33 of 2017 Statement (section 4) means that the 2017 text is no longer the operative SOP. Where decisions rely on SOP criteria, assessors must apply the 2025 Statement from its commencement date (section 2), and the network of interactions with other Statements (section 11) must be assessed against the Statements in force at the relevant time.

In summary, the Statement’s interactions with other laws are primarily as an evidentiary input into VEA/MRCA decision‑making, as a textual gloss that controls over ICD coding for this purpose, and as a node in the network of Statements of Principles that cross‑refer and apply mutually.

This instrument contains minimal internal amendment history, but it provides explicit information about replacement and dates.

Issuing and dating: The instrument is dated 24 October 2025 (cover page) and specifies its commencement date as 24 November 2025 (section 2). Those two dates identify when the instrument was finalised and when it becomes operative for relevant claims.

Repeal of prior Statement: Section 4 expressly repeals the Statement of Principles concerning cardiac myxoma (Balance of Probabilities) (No. 33 of 2017), which is identified by its Federal Register of Legislation number F2017L00465. The repeal is unconditional in the text; the 2017 SOP is therefore superseded by this instrument from the commencement date. The instrument does not set out transitional provisions or savings clauses in the text provided.

No other amendments recorded in the text: The instrument itself does not list prior amendments to this instrument (it is the current instrument) nor does it provide a schedule of amendments prior to 2017. The only express amendment history provided is the repeal of the 2017 Statement (section 4). The instrument does not include notes on consultation, explanatory memoranda, or iterative drafts within the text supplied.

Effect of repeal in practice: Repeal means that assessors must apply the 2025 Statement’s definitions, factors and relationship rules for claims falling within its commencement date and application clause (sections 2 and 5). The instrument does not specify how decisions made under the 2017 Statement before repeal are to be treated; the text provides no savings or transitional provision in relation to historical decisions.

Cross‑references to other Statements: Section 11 contemplates the possibility that other Statements of Principles will apply to factors mentioned in section 9. Because section 11 requires application of those other Statements “as in force from time to time,” future amendments to those other Statements will also affect the operation of this instrument by reference. The amendment history of other SOPs therefore has a potential indirect effect on how factors in this Statement are treated.

No recorded revocation clause beyond repeal: The instrument does not include a power to amend within the text; any future amendments would be effected by a subsequent Statement made under the enabling provision (subsection 196B(3) of the VEA). The instrument itself does not set an expiry or sunset clause.

Administrative record: The instrument identifies the Repatriation Medical Authority and Chairperson as the issuing officers (cover and section 3). It also includes the Federal Register number for the repealed instrument, which provides an audit trail to the prior SOP but no further amendment events are recorded here.

In short, the amendment history provided is confined to the repeal of the 2017 Statement and the dating/commencement of the current instrument; no other amendment events or transitional rules are included in the text supplied.

The Statement as supplied does not contain or reference any judicial decisions, administrative tribunal rulings, or litigation history. It names no cases and cites no judicial authority. The instrument is an administrative, statutory instrument issued by the Repatriation Medical Authority under subsection 196B(3) of the VEA (section 3); it does not map out or record past litigation.

Consequences for practitioners: Because the instrument does not record litigation, practitioners should not expect to find precedent or judicial interpretation cited within the text itself. Any case law that bears on the interpretation or application of Statements of Principles, the VEA, or the MRCA would need to be sourced outside this instrument. The Statement does not provide guidance on disputed interpretations or appeal routes beyond its application to claims under section 120B of the VEA and section 339 of the MRCA (section 5).

No administrative determinations recorded: The instrument does not summarise prior administrative decisions, medical panel findings or other tribunal material that might otherwise illuminate contested factual or legal questions relating to cardiac myxoma. It is a standalone Statement of Principles document.

Reference points provided in instrument: The instrument makes internal referential points that are relevant to litigation but are not themselves litigation history. These include the textual definition of cardiac myxoma (section 7(2)), the Authority’s view on the balance of probabilities (section 8), the three determinative factors (section 9), the requirement that a factor be related to relevant service (section 10), and the cross‑reference mechanism to other Statements (section 11). Any judicial review or merits review will therefore likely focus on how these textual provisions were applied to the facts of a particular claim, but the instrument itself provides no record of such litigation.

Actionable inference: Given the absence of litigation references, counsel and claim advocates should be prepared to develop evidentiary and legal arguments from first principles as to how the instrument’s textual elements should be applied to their client’s facts, bearing in mind that the instrument supplies the core definitions and criteria that assessors will be using in entitlement decisions.

In summary, the Statement contains no litigation history or case citations; the instrument is a medical‑evidentiary framework whose interaction with courts and tribunals must be explored through external legal research and any administrative or judicial review records not contained in this text.

The Statement’s brevity and textual framing create several discrete practical risks and pitfalls for claimants, decision‑makers and advisors. Below are specific items that warrant attention because they can materially affect outcomes.

Narrow list of determinative factors (section 9): The instrument requires at least one of three factors to exist. If a claimant’s clinical facts do not neatly fit one of these three boxes, connection on the balance of probabilities will not be established under this Statement. There is no residual “catch‑all” factor; the listed factors are conjunctive to the threshold that “at least one” must exist. Practitioners should therefore map client evidence precisely to the wording of section 9.

Ambiguity in “before clinical onset” and “clinical worsening”: The instrument uses temporal and clinical terms,“before clinical onset,” “immediately preceding clinical worsening,” and “clinical worsening”,that are not defined in the Statement. This creates evidentiary ambiguity about when clinical onset occurred and what constitutes clinical worsening for a particular patient. Resolving those points will rely on contemporaneous clinical records and expert evidence, and assessments may turn on fine chronological distinctions.

“Having a heart transplant before clinical onset” (section 9(1)): This factor is unusual in that it requires proof of a heart transplant prior to clinical onset. Practitioners should note that transplant records, operative reports, and dates of documented clinical onset are precise evidentiary items. If the transplant occurred after clinical onset, this factor will not apply.

“Blunt force trauma to the chest immediately preceding clinical worsening” (section 9(2)): The instrument’s note explains a medical mechanism,trauma can cause a myxoma to break up and embolise. However, the term “immediately preceding” creates a tight temporal requirement. Causation will need clinical correlation showing that the trauma temporally and pathophysiologically preceded worsening. Absent contemporaneous documentation of trauma and worsening, causal linkage may be difficult to establish.

“Inability to obtain appropriate clinical management” (section 9(3)): This factor turns on health‑system access and quality. The Statement does not define “appropriate clinical management,” nor does it set out what evidence suffices to show “inability to obtain” it. This creates potential evidentiary dispute about standard of care, availability of services, and whether efforts to obtain care were reasonable. Practitioners should compile referrals, waitlist records, correspondence, and notes showing attempts to obtain care and any systemic barriers.

Requirement that factor be related to relevant service (section 10): Even if a listed factor exists, it must be related to the person’s relevant service. The Schedule defines relevant service narrowly (eligible war service other than operational, defence service excluding hazardous and British nuclear test defence service, or peacetime service under MRCA). If the claimant’s service does not fit those categories, or if the temporal linkage between service and factor is weak, the claim may fail despite meeting a section 9 factor.

Clinical worsening where myxoma “suffered or contracted before or during (but did not arise out of) relevant service” (section 10(2)): This creates a particular evidentiary pattern: the Statement contemplates conditions that pre‑exist or are present during service but did not arise out of service, and yet are materially contributed to or aggravated by service‑related factors. That nuance can be a trap for claims that arose during service but are characterised as arising out of service or vice versa.

Cross‑reference to other Statements (section 11): Where a factor refers to another injury or disease covered by another SOP, that other SOP’s factors apply “as in force from time to time.” This means that claimants and advisers must identify and consult potentially multiple SOPs, including later amendments, to determine the applicable criteria. Failure to do so can produce missed arguments or reliance on superseded criteria.

Death definition and terminal events (section 7(5) and Schedule): The instrument counts death from cardiac myxoma if a terminal event was contributed to by myxoma. The Schedule’s definition of “terminal event” is specific. Where a death certificate lists one of the terminal events (for example, pneumonia or cardiac arrest), assessors must be satisfied that the terminal event was contributed to by myxoma. That causal inference may require retrospective medical interpretation and expert evidence.

ICD‑10‑AM coding note (sections 7(3)-(4)): Although the instrument references ICD coding, it states that the statutory meaning is the textual definition. Practitioners should not rely solely on coding entries; clinical definitions in subsection 7(2) control.

No penalties, no process rules in the Statement: The instrument does not set out appeals, time limits or procedural steps. Practitioners must look to the VEA and MRCA for procedural rights and remedies. Assuming administrative practice without checking the parent Acts is a potential oversight.

Repeal of the 2017 Statement (section 4): The repeal means prior decisions relying on the 2017 Statement may not align with the new criteria. Practitioners should review any decisions made under the old Statement and consider whether fresh applications or reviews are appropriate in light of the new text.

In short, the main “gotchas” are tight and sometimes undefined temporal and clinical terms, a short and specific list of factors, a burden to show relationship to relevant service as defined in the Schedule, and the need to cross‑check other Statements where factors implicate other injuries or diseases.

Compliance in this context means preparing and presenting a claim that satisfies the Statement’s requirements so that a decision‑maker applying the VEA or MRCA can find cardiac myxoma or death from cardiac myxoma to be connected with relevant service on the balance of probabilities. The Statement itself sets out the necessary evidentiary facts. Below are concrete steps, each grounded in the Statement’s text.

1. Confirm application of the Statement to the claim (section 5 and Schedule 1): First, establish that the claimant’s service falls within the Schedule’s definition of “relevant service” (eligible war service other than operational service, defence service other than hazardous and British nuclear test defence service under the VEA, or peacetime service under the MRCA). If the person’s service does not meet those categories, this Statement will not apply.

2. Identify whether the condition is cardiac myxoma as defined (section 7(2)): Ensure the claimant’s diagnosis corresponds to the textual definition in subsection 7(2): a benign neoplasm of the heart composed of primitive connective tissue cells and stroma resembling mesenchyme. Do not rely solely upon ICD‑10‑AM coding (sections 7(3)-(4)), because the Statement prioritises the textual definition.

3. If claiming death from cardiac myxoma, map the terminal event (section 7(5) and Schedule): If the claim concerns death, confirm that the death involved a terminal event as defined in Schedule 1 (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) and collect evidence that the terminal event was contributed to by the person’s cardiac myxoma.

4. Establish at least one section 9 factor with contemporaneous evidence:

   • For section 9(1) (heart transplant before clinical onset): obtain operative reports, transplant admission/discharge records, cardiology notes and documentation of clinical onset dates. The transplant must predate clinical onset to satisfy the wording.
   • For section 9(2) (blunt force chest trauma immediately preceding clinical worsening): compile emergency department notes, trauma summaries, imaging (CT/MRI), ambulance records, and contemporaneous clinical notes that show the trauma event and subsequent clinical deterioration in close temporal proximity. Note the Statement’s explanatory note about embolisation following trauma; use clinical records that can document embolic events if present.
   • For section 9(3) (inability to obtain appropriate clinical management before clinical worsening): assemble evidence of attempts to obtain care and systemic barriers. This may include referral letters, waitlist correspondence, treatment refusals, transfer records, correspondence with hospitals or health services, and clinical notes recording delays or lack of available therapy. Since “appropriate clinical management” is not defined in the instrument, gather expert opinion to characterise what appropriate management would have been and documentary evidence of inability to access it.

5. Demonstrate the relationship of the factor to relevant service (section 10): Show how the factor was related to the person’s relevant service. This will often require linking the timing or circumstances of service to the occurrence of the factor,for example, demonstrating that an injury (blunt chest trauma) occurred while the person was rendering relevant service, or that lack of access to appropriate management was caused by a service‑related deployment or posting. Where the myxoma pre‑dated service and the claim relies on “clinical worsening” during or after service, use subsection 10(2) to frame a material contribution or aggravation argument.

6. Where a factor refers to another injury or disease, consult the other Statement(s) of Principles (section 11): If a factor in section 9 implicates another injury or disease covered by a different SOP, obtain and apply that other Statement’s factors “as in force from time to time.” This may require gathering evidence and expert opinion relevant to the secondary SOP as well.

7. Prepare expert medical evidence to address causal questions: Because the Statement requires medical causation in the form of specific clinical sequences and contributions to terminal events, procure contemporaneous records and authoritative expert reports that interpret those records against the Statement’s definitions and factors. Experts should map clinical timelines to the instrument’s phrasing (for example, “immediately preceding clinical worsening”) and address whether cardiac myxoma contributed to any terminal event.

8. Anticipate and address definitional ambiguity: Because the Statement leaves terms such as “clinical onset,” “clinical worsening,” and “appropriate clinical management” without statutory definition, instruct experts to define those terms in the context of the claimant’s clinical history and to explain why the available evidence meets the Statement’s thresholds.

9. Document service history precisely: Provide service records, postings, deployment dates, and any incident reports that ground the temporal and causal relationship between relevant service and the factor relied upon. The Schedule’s definition of relevant service is the gate for the Statement’s application.

10. Cross‑check death claims against terminal events and contribution: For deceased claimants, collect death certificate details, autopsy reports (if any), pathology reports, and clinicians’ notes that link the terminal event to myxoma. The Schedule lists the specific terminal events that the Statement treats as examples.

11. Use the Statement as the evidentiary checklist in submissions: Structure submissions to decision‑makers by explicitly referencing the relevant sections (for example, “We rely on section 9(2): blunt force trauma to the chest immediately preceding clinical worsening,” and then supply the records and expert evidence mapped to that paragraph). Also identify any cross‑referenced SOPs per section 11.

12. Be mindful of the commencement and repeal dates (sections 2 and 4): Ensure that the claim is assessed under the correct Statement (No. 84 of 2025) from its commencement date. If reviewing historical determinations, note that the 2017 Statement was repealed by section 4; practitioners should consider whether review or reconsideration is warranted under the parent Acts.

Following these steps aligns a claimant’s preparation with the textual requirements of the Statement and assists decision‑makers in applying the instrument’s criteria. The Statement itself does not prescribe procedures for appeals or review; for those matters, consult the procedural provisions of the VEA and MRCA.