Statement of Principles concerning cardiomyopathy (Balance of Probabilities) (No. 58 of 2024)

The instrument organises its approach around several core legal‑medical concepts. First, cardiomyopathy is given a substantive clinical definition tailored to administrative application rather than pure nosology. Section 7(2) describes cardiomyopathy as “a heterogeneous group of acquired diseases of the heart muscle (myocardium) involving mechanical or electrical dysfunction” and lists included subtypes (dilated, restrictive, myocarditis with persistent dysfunction, hypertrophic, arrhythmogenic, hypertensive and takotsubo cardiomyopathy). The text also contains express exclusions (exercise‑induced remodelling, myocardial abnormality caused by ischaemic heart disease or valvular disease, and pericardial disease) which require decision makers to distinguish cardiomyopathy from those alternative diagnoses (section 7(2)(3)).

Second, the instrument uses the balance of probabilities as the legal standard for linking cardiomyopathy to service, and explicitly records the RMA’s medical‑scientific view underlying the selection of factors (section 8). The practical consequence is that the presence of any single listed factor in the required temporal relationship will satisfy the instrument’s threshold for a causal link on that standard (section 9 introductory text: “At least one of the following factors must exist before it can be said that, on the balance of probabilities, cardiomyopathy or death from cardiomyopathy is connected with the circumstances of a person's relevant service”).

Third, time and temporal relationship are central. Many factors are expressed as having to exist “before clinical onset or at the time of clinical worsening” (see e.g. s 9(1) radiation, s 9(2) myocarditis, the medications list in s 9(3) with a 3‑month window, anthracycline treatment within 25 years in s 9(12), chloroquine/hydroxychloroquine daily for at least 2 years in s 9(13)). For takotsubo cardiomyopathy the instrument sets tight proximal windows (for example, a severe stressful event within 14 days before onset or specific events like envenomation within 24 hours) (s 9(18)-(24)). The Schedule defines “MET” and other measurement terms that determine whether physical exertion or obesity meet the factor thresholds.

Fourth, the instrument recognises competing causes and interaction with other Statements of Principles. Section 11 requires decision makers to apply the factors in any other Statement of Principles referred to by a factor “in accordance with the terms of that Statement ... as in force from time to time.” This makes the instrument part of a networked administrative causation regime: where a listed factor is itself an injury or disease for which a separate Statement exists, that separate Statement governs the particulars.

Fifth, the instrument distinguishes “clinical onset” from “clinical worsening” both temporally and with respect to its relation to service. Section 10(2) constrains the clinical‑worsening aspects so they apply only where the person’s cardiomyopathy was suffered or contracted before or during (but did not arise out of) the person’s relevant service. That language introduces a categorical delimitation: the instrument’s clinical‑worsening rules are not the pathway for cardiomyopathy that “arose out of” service; such claims will be treated differently under the VEA/MRCA statutory schemes rather than via these worsening provisions.

Sixth, the instrument imports and fixes several diagnostic and quantitative thresholds in the Schedule. Examples are “being obese” (BMI ≥ 30), “iron overload” (elevated ferritin or transferrin saturation), MET units for exertion, anthracycline as defined drug class, and “terminal event” as a proximate or ultimate cause of death with a non‑exclusive list that includes respiratory and circulatory failure and cardiac arrest. These definitions standardise the evidentiary expectations for claimants.

Finally, the instrument’s content and currency are subject to formal amendment: the compilation notes and endnotes show the initial registration and a later amendment (see Endnote 3 and Endnote 4), and the text itself includes an editor’s note that subsection 9(2a) (SARS‑CoV‑2 infection) was added by Amendment No. 54 of 2025. That demonstrates that new medical evidence can be incorporated by amendment and that practitioners must check the current in‑force Statement when preparing or opposing claims.

Primary subjects

• Claimants: veterans and members of the Forces who lodge claims to which section 120B of the VEA or section 339 of the MRCA applies (section 5). The instrument determines, for those claimants, whether cardiomyopathy or death from cardiomyopathy can be connected to relevant service on the balance of probabilities.
• Decision makers: administrators, case officers and medical officers applying the VEA/MRCA claims processes who must use this Statement as the RMA’s view of medical causation (section 8), and who will apply the listed factors and definitions when deciding entitlement questions.

Medical professionals and expert witnesses

• Treating clinicians and medico‑legal experts who prepare reports and provide evidence for claims. The instrument’s definitions and temporal windows set evidentiary targets (for instance lab thresholds for iron overload, BMI calculation for obesity, documented dates for medication exposure including the 3‑month window and the 25‑year anthracycline window) (Schedule 1; section 9(3); section 9(12)). Clinicians will be expected to address whether the patient’s disease falls within the instrument’s cardiomyopathy definition (section 7(2)) and whether excluded diagnoses better explain the presentation (section 7(2)(3)).

Administrative agencies

• The Repatriation Medical Authority is the author of the instrument (section 8), and its view supplies the medico‑scientific premise for the instrument’s factors. The Department or agency responsible for adjudicating VEA/MRCA claims will use the Statement to adjudicate entitlement claims; it will therefore face budgetary and liability implications arising from awards shaped by these factors (the instrument itself does not set payment entitlements, but affects whether entitlement is found).

Secondary impacts

• Other stakeholders such as insurers, veterans’ advocacy groups and legal practitioners who represent claimants or respondents will be affected because the Statement sets objective criteria that will materially inform evidence strategies. Section 11’s cross‑reference rule means that when a listed factor refers to an injury or disease that sits under another Statement of Principles, parties must consult that other Statement as well.

Notably excluded persons and conditions

• People whose myocardial abnormality is caused by ischaemic heart disease or valvular disease or who have pericardial disease (section 7(2)(3)) fall outside the cardiomyopathy definition for this instrument and will not have those conditions linked by this Statement. Similarly, athlete’s heart (exercise‑induced cardiac remodelling) is specifically excluded (section 7(2)(3)). Claimants whose cardiomyopathy “arose out of” relevant service are treated differently in relation to the clinical‑worsening elements (section 10(2)).

Geographic and temporal scope

• The instrument takes effect for claims to which the cited statutory provisions apply. The compilation notes record the original registration (24 June 2024, commencement 23 July 2024) and an amendment (No. 54 of 2025, registered 16 April 2025, commenced 19 May 2025) (Endnote 3). Practitioners must confirm which version of the Statement is in force at the date of decision.

This instrument does not itself create statutory duties of the sort that attract penalties, but it imposes practical obligations on decision makers and shapes claimants’ evidentiary duties. The core legal effects are administrative and evidentiary.

Duties of decision makers and administrators

• Apply the instrument as the RMA’s view on medical causation. Section 8 records the RMA’s position that, on the available medical‑scientific evidence, it is more probable than not that cardiomyopathy can be related to relevant service. Administrators deciding VEA/MRCA claims must therefore treat the listed factors as the relevant causal criteria when considering whether a connection exists on the balance of probabilities (sections 8 and 9).
• Where a factor in section 9 refers to another injury or disease with its own Statement of Principles, decision makers must apply that other Statement “in accordance with the terms of that Statement of Principles as in force from time to time” (section 11). This creates a duty to consult and apply external Statements where cross‑references occur.

Evidentiary duties of claimants and medical witnesses

• Establish that at least one of the factors in section 9 existed in the temporal relationship required (generally “before clinical onset or at the time of clinical worsening”, with specific exceptions and windows). The instrument sets precise temporal markers for many factors (for example, medication use within the 3 months before onset or worsening for the listed drugs in section 9(3), anthracycline treatment within 25 years in section 9(12), and chloroquine/hydroxychloroquine use daily for at least 2 years in section 9(13)). Where a factor requires laboratory confirmation (for example, iron overload), the Schedule sets the diagnostic threshold (elevated ferritin or transferrin saturation).
• For factors involving behavioural exposures (notably alcohol), claimants bear the evidential burden of proving the consumption pattern. The instrument sets gendered thresholds and a method of calculation: for males an average of at least 80 grams of alcohol per day for at least 5 continuous years; for females an average of at least 40 grams per day for at least 5 continuous years, with a note that alcohol consumption is calculated using the Australian Standard of 10 grams per standard drink (section 9(14)-(15) and note).
• Where medication‑related cardiomyopathy is claimed under the “cannot be ceased or substituted” provision in section 9(4), the claimant must show the medication was being taken within the 3 months before onset or worsening and that either: (a) cardiomyopathy improved within days or weeks of discontinuing/tapering; or (b) cardiomyopathy redeveloped/worsened on rechallenge with the same medication. These are specific clinical and temporal evidentiary requirements.

Rights of claimants

• The instrument operationalises the claimant’s right to have cardiomyopathy causation assessed using the RMA’s evidence‑based factors. If a claimant can show any one of the specified factors in the required relationship to onset/worsening, that will be sufficient for the purposes of this Statement to establish connection on the balance of probabilities (section 9 intro). This creates an administrative pathway to acceptance where the relevant factor and temporal relationship are demonstrably present.

Limitations and implicit duties

• The clinical‑worsening elements apply only where cardiomyopathy was suffered or contracted before or during (but did not arise out of) relevant service (section 10(2)). This limits the availability of “worsening” as a path to connection for claims where cardiomyopathy arose out of service. There is therefore a duty on decision makers to determine, in each case, whether the cardiomyopathy “arose out of” service or whether it existed prior to/during service and was merely aggravated by service.

Procedural duties not specified

• The instrument does not specify procedural rights, time limits for claim lodgement, or appeal mechanisms; those remain governed by the VEA, MRCA and associated administrative law. The Statement is a technical medical instrument for use in adjudication rather than a source of procedural rules.

This Statement of Principles does not create criminal offences or civil penalties. It is an administrative instrument setting out the medical criteria that the Repatriation Medical Authority, and decision makers under the VEA and MRCA, will use in determining causation for entitlement claims. The instrument itself contains no enforcement provisions, fines, or licencing obligations.

Enforcement mechanism in practice

• The instrument’s “teeth” are administrative. It is enforced by its integration into the claims decision process under the VEA and MRCA: decision makers apply the Statement when determining whether cardiomyopathy or death from cardiomyopathy is connected with a person’s relevant service on the balance of probabilities (sections 5, 8, 9). A favourable finding under the Statement can lead to compensation or rehabilitation entitlements under the relevant Acts; an unfavourable finding may mean denial of such entitlements. The instrument does not specify the form of compensation or the procedural steps for enforcement; those are contained in the VEA and MRCA.

No criminal sanctions or regulatory penalties

• There are no penal provisions in the Statement. It neither imposes obligations that attract prosecution nor prescribes pecuniary penalties for non‑compliance. Its function is evidentiary and declaratory.

Implications for misconduct or misrepresentation

• While the Statement does not itself create penalties, misrepresentation or fabrication of evidence in support of claims would engage other legal and administrative rules outside this instrument (for example, general laws on fraud or the procedural rules of the administering agencies). Those external enforcement mechanisms are not described in this Statement; practitioners should not treat this instrument as affecting those separate legal regimes.

Reliance and administrative review

• The Statement will be used by decision makers in making administrative decisions. Those decisions will be subject to whatever internal review, merits review or judicial review processes are available under the VEA, MRCA and broader administrative law. The Statement itself does not set out review processes or create direct rights of review; it supplies the medico‑scientific criteria that feed into the administrative decisions which are reviewable under the statutory schemes.

Statutory authority and scope

• The instrument is made under subsection 196B(3) of the Veterans’ Entitlements Act 1986, which is its legal source of authority (section 3). It applies specifically to claims under section 120B of the VEA and section 339 of the MRCA (section 5). That linkage places the Statement into the statutory framework governing veterans’ entitlements and military rehabilitation and compensation claims: the Statement informs causation assessments under those statutes but does not itself alter the substantive entitlements those Acts create.

Cross‑reference to other Statements of Principles

• Section 11 directs that where a factor in section 9 refers to an injury or disease that has its own Statement of Principles under subsection 196B(3) of the VEA, the factors in that other Statement “apply in accordance with the terms of that Statement of Principles as in force from time to time.” This creates an operational interaction: proof of a listed factor may require application of, and reliance on, another Statement’s definitions and thresholds. Practically, that means adjudicators and practitioners must consult the other Statements current at the time of decision and may need to integrate multiple Statements when building or assessing a claim.

Use of ICD‑10‑AM coding

• The instrument notes that while cardiomyopathy attracts ICD‑10‑AM codes I42, I43 or O90.3, the operative meaning of cardiomyopathy for the Statement is the textual definition in section 7(2) (section 7(4)-(5)). It does, however, reference the ICD‑10‑AM edition and effective date for cross‑referencing (Tenth Edition, effective 1 July 2017). This signals that codified diagnostic categories are ancillary and that textual, clinical definitions govern how the Statement is applied.

Relation to other statutory amendments and the Legislation Act

• The endnotes of the compilation record interactions with the Legislation Act 2003. Endnote 4 indicates that certain provisions were repealed or otherwise affected by the Legislation Act (for example, Section 2 and Section 4 were repealed by provisions of the Legislation Act,Endnote 4). Those amendment entries show that this Statement’s text and numbering may have been modified in line with broader statute‑law housekeeping; practitioners should consult the in‑force consolidated text and the Register where necessary.

Diagnostic and standards alignment

• The Schedule supplies clinical and quantitative definitions (BMI, MET, iron overload thresholds) that intersect with standard clinical practice and laboratory thresholds. These definitions create points of contact between administrative adjudication and clinical diagnostic standards; evidence that complies with the Schedule’s definitions will be necessary to satisfy the factor requirements.

Interaction with claims and appeals under the VEA/MRCA

• Although the Statement is silent on procedural appeal routes, its determinations (when applied by decision makers) feed into the statutory entitlement determinations under the VEA and MRCA. Therefore, a finding made using the Statement will be subject to whatever review or appeal mechanisms those Acts provide. The Statement itself does not set procedural rights; it alters the evidentiary landscape within which statutory appeals may occur.

Amendment and temporal interaction

• The compilation includes a history of amendment (Endnote 3 and Endnote 4). Subsection 9(2a) (adding SARS‑CoV‑2 infection as a factor) was added by Amendment No. 54 of 2025. This demonstrates that the RMA’s Statements are dynamic instruments and that practitioners must check the current in‑force version and prior versions where temporal questions about the date of decision or date of injury arise.

The compilation includes a documented amendment history in the endnotes. Key factual items in that history are:

• Original instrument: Statement of Principles concerning cardiomyopathy (Balance of Probabilities) (No. 58 of 2024), registered 24 June 2024 (F2024L00761) and commenced 23 July 2024 (Endnote 3).
• Amendment: Amendment Statement of Principles concerning cardiomyopathy (Balance of Probabilities) (No. 54 of 2025), registered 16 April 2025 (F2025L00510) and commenced 19 May 2025 (Endnote 3). The compilation date is 19 May 2025 and the compilation notes state that the day of commencement of this Amendment Statement is 19 May 2025.

Provision‑level amendment notes (Endnote 4) record:

• Section 2 was repealed by a provision of the Legislation Act 2003 (listed in the amendment history as “rep LA s 48D”).
• Section 4 was repealed by the Legislation Act 2003 (listed as “rep LA s 48C”).
• Subsection 9(2a) was added by No. 54 of 2025 (this is the SARS‑CoV‑2 infection factor) (Endnote 4).

The compilation notes also state that the instrument, as published, shows the text of the law as amended and in force on 19 May 2025. The endnotes caution that the compilation does not show uncommenced amendments and that any uncommenced amendments are accessible on the Register (compilation front matter). The endnotes further explain the usual matters about the abbreviation key and misdescribed amendments (Endnote 1 and Endnote 2).

Practical implications of the amendment history

• The addition of subsection 9(2a) to include SARS‑CoV‑2 infection indicates that the RMA updated the Statement to reflect new medical evidence. That demonstrates precedent for the RMA to amend Statements to incorporate emerging medical science. Practitioners should therefore check the Register for more recent amendments after the compilation date.

Editorial and technical changes

• The endnotes record that certain structural provisions were repealed pursuant to the Legislation Act, which typically reflects standard procedural consolidation rather than substantive policy change. However, those editorial repeals may affect section numbering and cross‑references; practitioners should use the current compiled text and check endnotes when relying on section numbers in other documents or in pleadings.

The compiled instrument and its endnotes do not record any litigation or case law interpreting this Statement of Principles. The document contains no citations to judicial decisions and the endnotes do not list any legal proceedings or reported cases arising under this Statement. Accordingly, within the boundaries of this compilation, there is no litigation history to summarise.

Practical consequence

• Because the Statement is an administrative instrument used in statutory claims, legal challenges will arise, if at all, in the context of appeals from decision makers’ determinations under the VEA or MRCA, or in judicial review proceedings. None are recorded in the compilation. Practitioners should therefore be aware that the absence of an internal litigation history in this compilation does not preclude judicial or tribunal consideration of the Statement in future matters; it simply records that to date no such decisions are included in this text.

Recommendation for practitioners seeking precedent

• If precedent is required, practitioners should search the relevant administrative and judicial databases for decisions that mention this Statement of Principles, and check any decisions under the VEA or MRCA that may have applied or considered its factors after the compilation date. The instrument itself makes clear that it is an evidence‑based administrative tool; how courts and tribunals weight the RMA’s Statements in contested cases will emerge only from case law which, as of the compilation in this text, is not recorded here.

The instrument contains numerous technical features and traps for the unwary practitioner. The following are concrete points to watch, each grounded in the text.

One factor is sufficient

• The instrument says “At least one of the following factors must exist” before connection can be said to exist on the balance of probabilities (section 9 introduction). This means practitioners should not assume multiple factors are required; a single qualifying factor, properly evidenced in its temporal relationship to clinical onset or worsening, meets the Statement’s threshold.

Temporal windows and evidentiary specificity

• Many factors have precise time constraints. Examples include:
  • Medication list in section 9(3): drugs must have been taken “within the 3 months before clinical onset or clinical worsening.”
  • Anthracycline exposure in section 9(12): treatment “within the 25 years before clinical onset or clinical worsening.”
  • Chloroquine/hydroxychloroquine in section 9(13): taken daily for at least 2 years before onset/worsening.
  • Takotsubo stressor windows (14 days, 24 hours) (sections 9(18)-(24)). Failure to document dates that fit the stated windows risks rejection under the Statement. Practitioners must secure contemporaneous records showing exact dates of medication, radiation fields, infections, envenomation or stressors.

Gendered alcohol thresholds and method of calculation

• The alcohol factors use average grams per day thresholds with gender differentiation (s9(14)-(15)). The instrument specifies that alcohol consumption is calculated using the Australian Standard of 10 grams per standard drink. Practitioners should quantify consumption in grams per day over the required continuous 5‑year period and convert drinks to grams using the 10‑gram standard; ballpark or qualitative statements about heavy drinking will not reliably satisfy the Statement.

Exclusions and alternative causes

• The Schedule excludes myocardial abnormality caused by ischaemic heart disease or valvular disease and pericardial disease from the cardiomyopathy definition (s7(2)(3)). If clinical notes show ischaemic or valvular aetiology, the Statement will not apply; decision makers will need to treat the case under the relevant diagnostic category. Similarly, athlete’s heart is excluded.

Clinical worsening limitation

• The clinical worsening elements apply only where cardiomyopathy “was suffered or contracted before or during (but did not arise out of) the person's relevant service” (s10(2)). That wording can be a trap: if cardiomyopathy clearly “arose out of” service, the clinical‑worsening route is not the correct mechanism under this Statement. Parties must address whether the disease “arose out of” service or whether it existed prior to service and was aggravated by service.

Medication‑withdrawal/rechallenge rule

• The section 9(4) factor requires either a quick improvement on discontinuation/taper or redevelopment on rechallenge to qualify. This sets a high evidentiary bar: clinicians must be able to say that cardiomyopathy improved within days or weeks of stopping the suspected medication, or that it recurred on a rechallenge. Absent clear clinical documentation of these outcomes, this factor will fail.

Long look‑back period for anthracyclines

• Anthracycline exposure within the 25 years before onset/worsening is sufficient (s9(12)). This is a materially long latency window; historic chemotherapy records may be needed, and respondents should not assume old treatment is irrelevant.

Dependence on other Statements

• If a factor refers to an injury/disease covered by another Statement (s11), practitioners must locate and apply that other Statement “as in force from time to time.” Failure to check the current version of cross‑referenced Statements or to include required evidence under them can undermine a claim.

Diagnostics with numeric thresholds

• Certain terms require laboratory thresholds (for iron overload, Schedule 1 requires confirmation by elevated ferritin or transferrin saturation). BMI and MET are numerically defined. Ensure expert reports explicitly reference these metrics and the test results.

SARS‑CoV‑2 inclusion is recent

• Subsection 9(2a) adding SARS‑CoV‑2 was added by Amendment No. 54 of 2025 (Endnote 4). Practitioners should note that this was a post‑2024 amendment and check the operative date of any version relied upon. Clinical proof of SARS‑CoV‑2 infection prior to onset/worsening will be required.

“Unable to obtain appropriate clinical management”

• The factor in s9(25) (inability to obtain appropriate clinical management before clinical worsening) is phrased qualitatively and may be operationalised variably. Documentary evidence of attempts to access care and the absence of appropriate management will be necessary; subjective statements alone are unlikely to suffice.

Takotsubo specifics and narrow event windows

• Takotsubo cardiomyopathy factors are narrowly framed and time‑bound: severe stressful event within 14 days, ICU admission/artificial ventilation/major trauma/sepsis within 14 days, stroke/subarachnoid haemorrhage within 14 days, envenomation within 24 hours (s9(18)-(24)). Claims relying on takotsubo must show exact timing of the precipitating event relative to onset.

This section provides a practical compliance checklist for claimants, clinicians, legal advisers and case officers using the Statement. All steps refer to the Statement’s text and schedule definitions.

1. Confirm the instrument applies to the claim

   • Verify the claim is one to which section 120B of the VEA or section 339 of the MRCA applies (see section 5). If the claim is outside those statutory provisions, this Statement is not the operative RMA instrument for causation.

2. Establish the cardiomyopathy diagnosis within the Statement’s definition

   • Ensure the medical diagnosis fits the instrument’s cardiomyopathy definition (section 7(2)). Document the subtype where possible (dilated, restrictive, myocarditis with persistent dysfunction, hypertrophic, arrhythmogenic, hypertensive, takotsubo).
   • Rule out excluded categories explicitly in clinical reports: athlete’s heart, myocardial abnormality due to ischaemic heart disease, valvular disease, or pericardial disease (section 7(2)(3)). Include imaging, angiography, valvular assessments, and pericardial investigations as needed.

3. Select and prove a qualifying factor from section 9

   • Identify which specific factor in section 9 is being relied on. The Statement requires only one qualifying factor, but proof must be concrete.
   • For infection‑related factors (e.g., myocarditis, SARS‑CoV‑2, Trypanosoma cruzi, HIV): obtain laboratory confirmation, imaging, biopsy (if available), PCR/serology results and contemporaneous medical records that show infection preceding onset/worsening (sections 9(2), 9(2a), 9(3 omitted) etc).
   • For radiotherapy: produce radiotherapy records that demonstrate the heart was in the radiation field, with dates showing exposure before clinical onset or clinical worsening (section 9(1)).
   • For amyloidosis, sarcoidosis, iron overload or neoplasm infiltration: provide biopsy, imaging (e.g., MRI, PET), histology, and labs (iron overload requires elevated ferritin or transferrin saturation per Schedule) (section 9(6), (7), Schedule 1).
   • For endocrine disorders: provide endocrine test results and clinical diagnoses with dates preceding onset/worsening (section 9(8)).

4. Respect temporal windows and document them carefully

   • For the medication list in section 9(3): supply pharmacy records, prescription charts or administration records showing use within 3 months before onset/worsening.
   • For anthracycline exposure (section 9(12)): obtain historical oncology treatment records demonstrating treatment within 25 years of onset/worsening.
   • For chloroquine/hydroxychloroquine (section 9(13)): document continuous daily use for at least 2 years before onset/worsening.
   • For alcohol factors (sections 9(14)-(15)): compile a consumptive history quantified in grams per day over the continuous 5‑year period; convert standard drinks to grams using the Australian Standard (10 g = 1 standard drink).

5. When relying on medication withdrawal/rechallenge (s9(4))

   • Obtain clinical notes documenting improvement within days or weeks of discontinuation/tapering, or evidence of recurrence on rechallenge. If rechallenge was not attempted, provide an explanatory clinical rationale (but note the instrument requires either improvement on stopping or redevelopment on rechallenge).

6. For takotsubo cardiomyopathy (stress cardiomyopathy)

   • Provide tight time‑stamped evidence linking the precipitating event to the onset/worsening: for stressors, a documented severe stressful event with immediate psychological/clinical response within 14 days (section 9(18)); for envenomation, documentation of the envenomation within 24 hours (section 9(23)). Include ICU admission or artificial ventilation records if relying on those factors (section 9(19)).

7. For “inability to obtain appropriate clinical management” (s9(25))

   • Prepare documentary evidence of attempts to obtain care: referrals, appointment logs, correspondence, proof of unavailability of specialists or necessary treatments, and contemporaneous clinical notes showing deterioration linked to delayed or denied care.

8. Use Schedule thresholds and definitions

   • Calculate BMI (Schedule 1: BMI = W/H2) to verify “being obese” (BMI ≥ 30) for section 9(9).
   • Use MET values (Schedule 1) when asserting intense physical activity of at least 6 METs (section 9(17)).
   • For iron overload, ensure laboratory results show elevated ferritin or transferrin saturation (Schedule 1).

9. Cross‑reference other Statements where applicable

   • If the chosen factor refers to an injury or disease covered by another Statement, identify that Statement and gather evidence required by it; section 11 requires the other Statement to be applied as in force.

10. Address the relationship to relevant service

    • Establish that the qualifying factor “must be related to the relevant service rendered by the person” (section 10(1)). Provide service records, deployment or treatment logs, and any contemporaneous military medical records linking exposure or event to the individual’s relevant service history.
    • If relying on clinical worsening, confirm the cardiomyopathy was suffered or contracted before or during (but did not arise out of) the relevant service, and document the timing of worsening relative to service (section 10(2)).

11. Prepare expert opinion tailored to the Statement

    • Ask experts to address: (a) diagnosis and whether it fits the Statement’s cardiomyopathy definition; (b) whether any excluded diagnosis explains the presentation; (c) whether the selected factor existed in the temporal relationship required; (d) whether the factor is related to relevant service; and (e) whether the factor satisfies any numeric/diagnostic thresholds in the Schedule. Expert opinion should explicitly map clinical findings to the Statement’s clauses.

12. Verify current in‑force text and amendments

    • Check the Register and the compiled text for amendments (e.g., subsection 9(2a) was added by No. 54 of 2025) and confirm the version relevant to the date of decision or claim lodgement (Endnote 3 and Endnote 4).

13. Record and present primary source documents

    • Use primary source evidence wherever possible (radiotherapy plans, medication administration records, hospital discharge summaries, lab prints, biopsy reports). Secondary recollections are less persuasive against the Statement’s precise temporal and numeric requirements.

14. Anticipate cross‑issues and contradictory causes

    • If the clinical record suggests comorbidities (ischaemic disease, valvular disease, pericardial disease) explore whether those offer a better explanation; if so, the Statement may not apply and the claim will need to be treated under the appropriate diagnostic category.

Following this checklist will align evidence gathering and expert opinion to the Statement’s specific requirements and temporal parameters, thereby improving the likelihood that a decision maker will find a connection on the balance of probabilities under the RMA’s instrument.