Statement of Principles concerning cataract (Reasonable Hypothesis) (No. 15 of 2026)

The central concept is the “reasonable hypothesis” standard, which is a lower threshold than proof on the balance of probabilities. Under section 120A of the VEA, for claims relating to service rendered after 31 May 1994, a Statement of Principles must be applied. If a claimant raises a reasonable hypothesis connecting the condition to service, the Repatriation Commission must determine the claim to its reasonable satisfaction that the injury or disease was not war-caused or defence-caused (reverse onus). The SOP lists factors that the RMA has determined are sufficient to raise such a hypothesis. The instrument defines “cataract” as partial or complete opacification of the lens or lens capsule causing visual impairment, excluding congenital or infantile cataract and lens malformation. Death from cataract includes death from a terminal event contributed to by the cataract. The key factors in section 9 range from environmental exposures (sunlight, ionising radiation, TNT) to trauma (penetrating, blunt, thermal, chemical, explosive blast, electrical injury), medical conditions (diabetes, chronic hypoparathyroidism, chronic renal failure if under 60, high BMI), medications (corticosteroids, phenothiazine, tamoxifen), inflammatory conditions (uveitis, scleritis with anterior chamber inflammation), and a catch-all factor of “inability to obtain appropriate clinical management” for clinical worsening. The instrument introduces a metric called “latitude equivalent hours” for sunlight exposure, which multiplies actual hours by a weighting factor depending on latitude (tropical 1.0, subtropical 0.75, warm temperate 0.5, cool temperate 0.25). The threshold is 2,250 latitude equivalent hours, which is a high bar: for example, 2,250 hours of direct sun in a tropical zone (weight 1.0) equates to roughly 1.5 hours per day over four years, but in a cool temperate zone (weight 0.25) it would require 9,000 actual hours. The “unprotected eye” means no sunglasses with good UV protection (category 2 or above), no brimmed hat, and no other physical barrier. This definition imposes a behavioural assumption that service personnel did not wear adequate eye protection. For ionising radiation, the dose threshold is a cumulative equivalent dose of at least 0.2 sievert to the affected eye, calculated under ARPANSA guidelines. This is a relatively low dose (equivalent to about 20 chest CT scans or 2,000 chest X-rays). The inclusion of “inability to obtain appropriate clinical management” as a factor (section 9(19)) is significant because it applies only to clinical worsening, not initial onset. It allows a claim to succeed if the person could not get timely cataract surgery or other management due to service circumstances (e.g., remote posting, lack of facilities). This factor is inherently subjective and hard to disprove, creating moral hazard. The instrument also imposes temporal windows for many factors (e.g., within 20 years for trauma, 5 years for electrical injury, 3 months for explosive blast). These windows reflect epidemiological assumptions about latency, but they also cut off older exposures. The “relationship to service” requirement in section 10 states that the factor must be related to the person’s relevant service. This means the exposure or event must have occurred during and because of service. For clinical worsening of a pre-existing cataract, the factor must materially contribute to aggravation. The instrument does not specify how the causal link between the factor and service is to be proved; that is left to the claims process.

The primary class of affected persons is veterans, members of Peacekeeping Forces, and members of the Forces under the VEA, as well as members under the MRCA. Specifically, those who have rendered “relevant service” as defined: operational service, peacekeeping service, hazardous service, British nuclear test defence service, warlike service, or non-warlike service. The instrument covers claims for cataract or death from cataract. It affects claimants and their dependants who seek compensation for vision loss due to cataract allegedly related to service. It also affects the Repatriation Commission, which must adjudicate claims with reference to this SOP. The DVA is the administrative body processing claims. Medical professionals who provide opinions on causation will need to understand the specific definitions and thresholds. For example, an ophthalmologist assessing a veteran’s cataract might be asked to opine on whether the patient had accumulated 2,250 latitude equivalent hours of unprotected sun exposure during service. Legal practitioners representing claimants will use this SOP as a checklist to identify a qualifying factor. The instrument also affects the broader taxpayer, as successful claims increase the cost of the veterans’ compensation system. The RMA, as the maker, is affected in its ongoing role: it must ensure the SOP is based on sound medical-scientific evidence and must update it periodically. The repeal of the 2016 SOP means that claims determined after 23 March 2026 must be assessed under the new version. Claimants who had previously lodged claims but not yet been determined will be subject to the new SOP if the decision is made after commencement. The instrument does not affect civilians or non-veteran patients. However, the definitions could influence clinical practice indirectly: for example, the emphasis on cumulative sun exposure might prompt veterans to seek evidence of service records that document outdoor duties. The inclusion of factors like diabetes and high BMI (≥25 for 5 years) means that veterans with common lifestyle conditions can more easily establish a link to service if those conditions arose during service. This could expand the pool of successful claims for conditions that are widespread in the general population. The “under 60 years only” limitation for chronic renal failure as a factor means older veterans cannot use that pathway, which may affect equity but reflects the RMA’s view that the causal link is weaker with age. The instrument does not directly affect private health insurers, but it may reduce the number of private claims for cataract surgery among veterans who instead obtain compensation from the government. This substitution effect shifts the cost from individuals and insurers to the public purse. The compliance burden on the DVA includes the need to train staff in calculating latitude equivalent hours and cumulative equivalent dose, and to engage experts when necessary. The instrument also affects the Military Rehabilitation and Compensation Commission, which administers the MRCA claims.

The instrument does not create duties directly; it is a legislative rule that affects the operation of existing duties under the VEA and MRCA. The key duty is on the Repatriation Commission (and the MRCA Commission) to determine claims in accordance with the applicable SOP. Under section 120A of the VEA, the Commission must be satisfied that there is a reasonable hypothesis connecting the cataract to service, having regard to the SOP. If the claimant points to a factor in section 9 that is related to their service, the Commission must accept that a reasonable hypothesis exists unless it finds that the factor does not in fact exist or is not related to service. The Commission has a duty to seek evidence from the claimant and to consider all relevant material. The claimant has the right to put forward evidence of any of the factors. The instrument gives claimants a right to rely on a presumption: if they can satisfy the threshold for any one factor, the burden shifts to the Commission to disprove the connection on the balance of probabilities. The factor of “inability to obtain appropriate clinical management” (section 9(19)) creates a right to argue that the cataract worsened because the person could not get timely treatment due to service. This is a departure from the normal rule that a condition’s worsening must be directly caused by service; here, the lack of access is itself a factor. The instrument also gives the RMA the authority to determine SOPs and to repeal them. The right of the RMA to set factors is broad, subject to the requirement of sound medical-scientific evidence. Claimants have no right to challenge the SOP directly under the Act; they can only challenge its application to their case. The duty of the RMA is to keep SOPs under review and ensure they reflect current medical understanding. The instrument does not create any private rights of action. It is a tool for public law decision-making. The definitions impose duties on the decision-maker to interpret terms strictly. For example, “unprotected eye” requires the decision-maker to determine whether the veteran wore sunglasses with lens category 2 or above, a brimmed hat, or other physical barrier. This may require the Commission to obtain records of issued equipment or the veteran’s testimony. There is a duty on the claimant to provide reasonable evidence of the factor. The instrument does not specify the standard of proof for establishing the factor itself (i.e., whether it is on the balance of probabilities or beyond reasonable doubt). In practice, administrative decision-makers often apply the civil standard, but this is not set out in the instrument. The factor of “smoked at least 10 pack-years” imposes a duty to calculate pack-years accurately using the formula in the dictionary: divide cigarettes per day by 20, multiply by years. For pipe tobacco and cigars, 1 gram equals one cigarette. This creates an administrative burden to convert tobacco consumption to cigarette equivalent. The factor for TNT exposure requires proof of inhalation or cutaneous contact on more days than not for at least 10 years before onset - a detailed exposure history.

This instrument does not contain penalties. It is a Statement of Principles under Part XIA of the VEA, not a criminal or civil penalty provision. Enforcement mechanisms arise from the broader veterans’ compensation framework. If a claimant knowingly provides false information to establish a factor, they may be subject to prosecution for fraud under the Criminal Code or for making a false statement under the VEA (section 205). The instrument itself is simply a definitional tool. Non-compliance by the Repatriation Commission - such as failing to apply the SOP correctly - can be challenged in the Administrative Appeals Tribunal (AAT) or on judicial review to the Federal Court. The instrument does not create any direct penalty for the veteran. Instead, the consequences of non-compliance with the instrument by a decision-maker are that the decision may be set aside or remitted. There is no specific enforcement body for this SOP; the RMA is not an enforcement agency. The Commonwealth Ombudsman may oversee the administration of claims, but again not enforcement. The instrument could indirectly affect enforcement of other laws: for example, if a factor involves exposure to ionising radiation, the relevant safety standards under the ARPANSA code might be enforced separately. However, this SOP does not impose a duty on the Defence Force to protect eyes from sunlight or radiation; it merely allows compensation if the exposure occurred and caused cataract. The absence of penalties in the instrument means it operates purely as a factual and causal rule. This is typical for SOPs. The real “enforcement” is through the claims process: if a veteran does not meet any factor, their claim is likely to be rejected. There is no penalty for raising a factor that is not proven, but if there is evidence of fabrication, the claim can be refused and the veteran might face criminal charges. From an economic perspective, the lack of penalties for abusive claims (e.g., claiming inability to obtain clinical management) could lead to moral hazard. The instrument relies on the Commission’s ability to test the evidence. The cost of defending against weak claims falls on the taxpayer. The only deterrence is the potential for criminal fraud, which has a high evidentiary bar.

This instrument is made under subsection 196B(2) of the VEA. It is a legislative instrument subject to the Legislation Act 2003. It interacts primarily with the VEA (Part XIA, sections 196A to 196G) and the MRCA (Part 7, Division 3, sections 335-343). Under the VEA, section 120A provides that for claims relating to service on or after 1 July 1994, the Commission must not determine that a disease is war-caused unless it is satisfied that a reasonable hypothesis exists and that the hypothesis is consistent with the SOP. This instrument specifies the factors that constitute a reasonable hypothesis. It also interacts with the Military Rehabilitation and Compensation Act 2004, section 338 of which applies the same SOP framework. The instrument must be read together with the Veterans’ Entitlements (Repatriation Medical Authority) Regulations 1995, which govern the RMA’s procedures. The instrument specifically cross-references other SOPs via section 11: if a factor refers to an injury or disease covered by another SOP, the factors from that other SOP apply. For example, factor 9(12) is “having diabetes mellitus for at least the 5 years immediately preceding clinical onset”. To establish that the veteran has diabetes mellitus, the decision-maker may need to refer to the SOP for diabetes (if one exists). That SOP will have its own factors (such as obesity, genetic predisposition, etc.) that must be related to service. This creates a chain of causation. The instrument also refers to ICD-10-AM codes (H25, H26.1-H26.9, H28.1, H28.2) but clarifies that the meaning of cataract is not limited to those codes; they are only for coding purposes. This avoids a narrow reading that would exclude conditions that meet the clinical definition but fall under a different code. The instrument operates concurrently with the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (DRCA) for some claims, but the SOP framework applies only to VEA and MRCA claims. Veterans have a choice between Acts for some injuries; this SOP applies only to claims under VEA and MRCA. The instrument may also interact with state workers’ compensation laws if the veteran is also a current employee, but typically those are separate. The ARPANSA Guide to calculation of cumulative equivalent dose is incorporated by reference, as is the ICD-10-AM Tenth Edition. These external documents are not set out in full, so the decision-maker must have access to them. This incorporates standards that can change over time, though the specific edition is fixed (e.g., the ARPANSA guide “as in force on 2 August 2017”). The instrument also interacts with the general law of evidence in administrative proceedings. The AAT has discretion to admit hearsay and other evidence, but the SOP limits the kinds of causal theories that can be accepted. The instrument does not override the Public Service Act 1999 or the Defence Force Discipline Act 1982. It also interacts with the Freedom of Information Act 1982: a claimant can seek access to the RMA’s reasons for including or excluding factors, though the instrument itself is published.

This instrument is a new determination that repeals and replaces the Statement of Principles concerning acquired cataract (Reasonable Hypothesis) (No. 87 of 2016) (F2016L01694). The 2016 instrument was made under the same subsection 196B(2) of the VEA. The current instrument commences on 23 March 2026. The only amendment history provided in the source is that it replaces the 2016 version. There is no earlier version cited. The RMA may have revised the factors based on new evidence or changes in medical understanding. The 2016 instrument presumably had the same structure but different thresholds or factors. For example, the current instrument includes a factor for explosive blast (section 9(7)) which may not have been in the 2016 version. The current instrument also includes a specific definition for “latitude equivalent hours” which might have been refined. The instrument is not itself amended; it is a standalone instrument. It is possible that the 2016 instrument had a different sunlight exposure threshold or different latency periods. The current instrument includes “inability to obtain appropriate clinical management” as a factor (section 9(19)), which might be new. The RMA does not provide an explanatory statement in the source, so we cannot know the rationale for changes. The amendment history is solely that it supersedes the 2016 SOP. This is typical for SOPs: they are remade every few years to reflect updated evidence. The RMA has the authority to determine SOPs and to repeal them under section 196B. The repeal is expressed in section 4. There is no indication of any other amendments between 2016 and 2026. The instrument is subject to disallowance by Parliament under the Legislation Act 2003, but that does not constitute amendment history.

The source does not refer to any specific litigation. However, the 2016 predecessor and earlier SOPs for cataract have likely been considered in the Administrative Appeals Tribunal and the Federal Court. The High Court has considered the reasonable hypothesis test in cases like Repatriation Commission v Deledio (1998) and later refinements. The Federal Court has considered whether a particular factor in an SOP was established on the evidence. However, we cannot name cases not mentioned in the source. We can note generally that litigation often centres on whether a factor “exists” and whether it is “related to service”. For example, the “penetrating trauma” factor requires a foreign body or other object entering the eye; claimants may argue that a corneal scratch constitutes penetrating trauma, while the Commission may disagree. The “blunt trauma” factor requires symptoms lasting at least 3 days; there may be disputes over whether the symptoms were actually caused by the trauma and whether they lasted 3 days. The “inability to obtain appropriate clinical management” factor is likely to be litigated because it is vague. Claimants may argue that a delay in surgery due to the DVA’s administrative processes constitutes inability to obtain management. The instrument’s definitions (latitude equivalent hours, cumulative equivalent dose) are technical and may require expert evidence. The AAT may hear evidence from meteorologists and radiation physicists. The Federal Court may review AAT decisions on questions of law, such as the interpretation of “unprotected eye” or “good ultraviolet radiation protection”. The litigation history is not zero, but the source does not provide it. We must not invent any. The instrument’s own provisions will shape future litigation. The factors are designed to be objective, but their application requires subjective judgments, which will generate disputes. The cost of litigation is borne by the parties (and ultimately the taxpayer for represented veterans). The instrument thus indirectly increases the volume of disputes, as the factors provide multiple potential avenues for claim, each with its own evidentiary issues. The government may settle claims to avoid litigation costs, which the instrument facilitates by providing a clear checklist.

Several provisions in the instrument can trap the unwary. First, the definition of “unprotected eye” requires that the eye be directly exposed and not protected by sunglasses with lens category 2 or above, a brimmed hat, or other physical barrier. This means that wearing ordinary sunglasses without a UV-rated category 2 label may not count as protection. Veterans who wore polarised sunglasses but not certified category 2 might still be considered unprotected. Also, wearing a baseball cap (not a brimmed hat) may not provide sufficient protection because the brim may not shade the eye adequately. The decision-maker will need to assess the type of eyewear and headgear worn during service, which may be decades ago and poorly documented. Second, the latitude equivalent hours calculation: hours are multiplied by a weighting factor. Actual hours spent in sunlight are not the same as latitude equivalent hours. A veteran who spent 2,250 hours in a cool temperate zone (weight 0.25) would have only 562.5 latitude equivalent hours, far below the threshold. Many veterans served in temperate Australia (e.g., Victoria) and might mistakenly believe they meet the threshold when they do not. Conversely, service in tropical areas (e.g., Papua New Guinea) is heavily weighted. The instrument also says “sunlight exposure to the unprotected eye” - it does not require that the entire body be exposed, just the eye. So a person wearing a full body suit but no eye protection still counts. Third, the factor for “intraocular surgery to the affected eye within the 2 years immediately preceding clinical onset or clinical worsening” (section 9(5)) appears to allow the surgery itself to be a cause of cataract. This is counterintuitive: surgery is treatment, but the factor suggests that having surgery on the eye can cause cataract to develop or worsen. This likely refers to cataract as a complication of intraocular surgery (e.g., for retinal detachment). Claimants may argue that a cataract that appears after eye surgery is service-related if the surgery was for a service-related condition. Fourth, the “inability to obtain appropriate clinical management” factor (section 9(19)) applies only to “clinical worsening” (not initial onset). But any worsening of vision due to cataract progression could be attributed to a delay in surgery. If a veteran could have had cataract surgery sooner but for service (e.g., deployed overseas with no ophthalmology), the clinical worsening factor might be satisfied. This is very broad and subjective. The Commission will have to determine whether the inability was due to service circumstances or merely to the veteran’s own choices. Fifth, the smoking factor requires 10 pack-years. This is a lower threshold than for some other conditions (e.g., lung cancer often requires 20 pack-years). Veterans who smoked lightly but over many years may cross the threshold. That said, the instrument requires that the smoking must be related to service - meaning the veteran must have smoked while serving (or as a result of service). Mere pre-service or post-service smoking does not count. Sixth, the factor for high BMI (25 or greater for at least 5 years) captures a very large portion of the population. If the veteran developed obesity during service (e.g., due to sedentary duties or dietary changes), they can argue that the obesity is service-related and then use that to claim cataract. But note: the BMI factor does not require that the high BMI itself be service-related; only the factor must exist and be related to service. The relationship to service is established if the veteran was obese during service (which is likely for many). This creates an easy pathway, especially since the causal link between obesity and cataract is uncertain but the SOP accepts it. Seventh, the definition of “cumulative equivalent dose” from ARPANSA is specific to the methodology as in force on 2 August 2017. If ARPANSA updates its guidelines after that date, they are not incorporated; the older version applies. This could lead to inconsistency with current radiation protection science. Eighth, the instrument includes a factor for “being treated with one of the following medications: … for anterior subcapsular cataract only, receiving a cumulative dose of at least 750 grams of a phenothiazine.” This is a subtype-specific factor. Most cataracts are nuclear sclerotic, not anterior subcapsular. Claimants with typical age-related cataract cannot use this factor unless they have the specific subtype, which requires an ophthalmologist’s diagnosis. This nuance is easy to miss. Ninth, the instrument says “having chronic hypoparathyroidism with hypocalcaemia for at least 3 months before clinical onset or clinical worsening of cortical or subcapsular cataract.” Again subtype-specific. The decision-maker must distinguish between cortical and subcapsular cataract. Tenth, the factor for TNT exposure requires “on more days than not, for at least 10 years” - a very specific exposure pattern that few veterans would meet. This factor is likely rarely used. These gotchas mean that claimants and their representatives need to pay close attention to the exact wording and definitions. The instrument is designed to provide clarity but also creates a dense set of conditions that can either help or trip up a claim depending on the quality of evidence.

Compliance with this instrument is not required from veterans or private citizens; rather, it is a rule that must be applied by the Repatriation Commission and the MRCA Commission when determining claims. The Commission must ensure that its decision-makers are trained on the definitions and that claims are assessed in accordance with section 9. To comply, the Commission should maintain a checklist for each factor. For example, for the sunlight factor, the decision-maker must obtain evidence of the veteran’s service locations, the number of hours spent outdoors without adequate eye protection, and calculate latitude equivalent hours using the table. This requires access to service records, meteorological data, and possibly expert evidence from an ophthalmologist or epidemiologist. The Commission should issue internal guidelines on how to interpret “unprotected eye” and what constitutes “good ultraviolet radiation protection”. For the ionising radiation factor, the Commission must have access to the ARPANSA guide and may need a radiation physicist to calculate cumulative equivalent dose. The Commission should also ensure that when a claim relies on a factor that refers to another injury or disease (e.g., diabetes), it cross-references the relevant SOP. This requires maintaining a database of current SOPs. The Commission must also apply the relationship to service requirement: each factor must be related to the person’s relevant service. This means for a factor like “having a Body Mass Index of 25 or greater for at least 5 years”, the Commission must determine whether the veteran’s high BMI was caused or contributed to by service (e.g., due to service-related injury limiting exercise, or service-provided diet). If the veteran was obese before service and remained so, the factor may still exist but must be “related to” service - this could be argued if the service prevented weight loss or contributed to weight gain. The instrument does not define “related to” further; case law from the AAT will guide. To comply, the Commission should adopt a consistent approach. For the “inability to obtain appropriate clinical management” factor, the Commission must assess whether the veteran could not access cataract surgery or other treatment because of service. This might include deployment to a remote area, lack of timely referral, or administrative delays by the DVA. The Commission should document its reasoning. Claimants can comply by gathering evidence to support their chosen factor. A lawyer advising a veteran should obtain service records, medical records, and a report from an ophthalmologist stating the type of cataract. For the sunlight factor, the veteran should list all overseas postings and estimate outdoor hours using unit diaries. For the corticosteroid factor, the veteran should provide pharmacy records. Commission best practice is to adopt a checklist and issue reasons that explicitly address each claimed factor and explain why it is or is not satisfied. The instrument also requires that for claims involving death from cataract, the terminal event must be contributed to by the cataract. The Commission should obtain a death certificate and medical evidence linking cataract to death (e.g., pneumonia from immobilisation due to visual impairment). The Commission should also maintain awareness of the repeal date: claims lodged after 23 March 2026 are covered by the new SOP; claims already determined under the 2016 SOP remain unaffected unless reopened. To avoid errors, the Commission should train all decision-makers on the differences between the 2016 and 2026 versions. There is no formal compliance fee or penalty for the Commission, but failure to apply the SOP correctly can lead to appeal and adverse costs orders. Compliance is ultimately about ensuring that decisions are legally sound, which reduces litigation risk and ensures proper use of public funds. The instrument itself is silent on recordkeeping, but the Archives Act 1983 would apply.