Statement of Principles concerning cervical dystonia (spasmodic torticollis) (Balance of Probabilities) (No. 42 of 2025)

This SOP is short and conceptually narrow. Its core legal and medical concepts in the instrument are the definitions of the condition, the evidentiary factor(s) required to establish service connection, the relationship requirement to relevant service, and how the SOP interacts with other SOPs and statutory schemes.

Definitions

• Cervical dystonia (spasmodic torticollis) is defined positively as a chronic focal dystonia characterised by sustained or intermittent involuntary neck muscle contractions causing repetitive or abnormal movements or postures of the head, neck, and shoulders (s7(2)(a)). The instrument then lists seven specific exclusions, including drug‑induced dystonia, generalised or hemidystonia, paroxysmal dystonia, congenital dystonia, dystonia resulting from a neurological disorder, dystonia resulting from a structural lesion of the brain or cervical cord, and dystonia resulting from a local lesion of the cervical region (s7(2)(b)(i)-(vii)). The SOP notes that ICD‑10‑AM code G24.3 is associated with the condition but that, for the SOP’s purposes, the statutory text in subsection 7(2) governs the meaning (s7(3)).
• Death from cervical dystonia is included where a terminal event or condition was contributed to by the person’s cervical dystonia, and the Schedule gives examples of terminal events including pneumonia, respiratory failure, cardiac arrest, circulatory failure, and cessation of brain function (s7(4); Schedule 1).

Evidentiary factor

• The SOP contains a single listed factor that must exist for a finding of connection: inability to obtain appropriate clinical management for cervical dystonia before clinical worsening (s9(1)). The instrument states that at least one of the factors in s9 must exist before it can be said, on the balance of probabilities, that the condition is connected with relevant service (s9 introductory sentence).

Relationship to service

• Any factor relied on must be related to the person’s relevant service (s10(1)). Further, the s9(1) factor is expressly limited to cases of material contribution or aggravation where the dystonia was suffered or contracted before or during, but did not arise out of, the person’s relevant service (s10(2)). The instrument’s Schedule defines “relevant service” to mean 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).

Interaction with other SOPs and classifications

• If a factor in s9 refers to an injury or disease for which another SOP has been determined, the other SOP applies in accordance with its terms as in force from time to time (s11). The SOP also references a specific edition of the ICD‑10‑AM for coding purposes but foregrounds the SOP’s textual definition (s7(3)).

Standard of proof and legal basis

• The instrument is expressed as applying the balance of probabilities standard. The RMA records that “on the sound medical‑scientific evidence available” it is of the view that it is more probable than not that the condition can be related to relevant service (s8). The statutory source is subsection 196B(3) of the VEA, under which the RMA makes SOPs (s3).

Taken together, the SOP is a medical standard specifying a narrow nexus pathway: a qualifying diagnosis that fits the defined clinical description, with proof that inability to obtain appropriate management before worsening occurred and that inability is related to the person’s relevant service in the particular temporal and causation circumstances described in s10(2).

The primary subjects of this SOP are persons who lodge claims under section 120B of the VEA or section 339 of the MRCA where cervical dystonia or death from that condition is alleged (s5). Those persons will typically be veterans or former members of the Forces, and the Schedule explicitly says the SOP concerns relevant service as defined for VEA and MRCA purposes (Schedule 1).

Decision makers and medical assessors

• Decision makers who decide entitlement under the VEA and MRCA will use this SOP as the RMA’s medical guidance when assessing whether, on the balance of probabilities, cervical dystonia or death from cervical dystonia is connected with relevant service (s3, s8, s5). The RMA itself is the instrument maker; the SOP functions as medical‑evidentiary content to be applied in statutory claim processes, rather than an administrative decision in an individual case (s3).

Health professionals and evidence providers

• Treating clinicians, forensic and occupational physicians, and consultants who prepare medical reports for claimants will be affected because the SOP specifies the diagnostic definition and the specific nexus factor that must be established (s7(2), s9(1)). Their reporting will need to address whether the condition fits the SOP definition, whether the person could or did obtain appropriate clinical management before clinical worsening, and how any inability to obtain management relates to relevant service.

Service providers, records managers and veteran support organisations

• Agencies that hold service medical records, hospital records and appointment histories will be asked for documentary evidence that bears on the s9 factor (inability to obtain appropriate clinical management before clinical worsening) and on timing relative to relevant service. The Schedule defines what counts as relevant service, limiting the types of service that may be implicated (Schedule 1).

Not affected or excluded

• Individuals whose dystonia falls into one of the listed exclusions are outside the scope of this SOP. The instrument expressly excludes drug‑induced dystonia, generalised or hemidystonia, paroxysmal dystonia, congenital dystonia, dystonia resulting from a neurological disorder, dystonia resulting from a structural lesion of the brain or cervical cord, and dystonia resulting from a local lesion of the cervical region (s7(2)(b)(i)-(vii)). Accordingly, claims for those varieties of dystonia will not be decided under this SOP’s factors. The SOP also confines the s9(1) factor to cases where the condition was suffered or contracted before or during relevant service but did not arise out of that service (s10(2)); persons whose cervical dystonia arose out of relevant service may require different nexus reasoning or another SOP.

Temporal and jurisdictional scope

• The SOP comes into force for claims considered following its commencement on 19 May 2025 (s2). It also expressly repeals the prior SOP No. 64 of 2016 (s4), so decision makers must apply this instrument in place of the earlier SOP from the commencement date. The instrument contains no transitional provisions; it simply states the repeal (s4). Practitioners and claimants must therefore check whether claims decided after commencement are governed by the new text.

In sum, the rules in this instrument operate within the VEA and MRCA claim framework and will affect claimants, their medical evidence providers, and the administrative decision makers responsible for applying the SOP to determine whether legal connection to relevant service exists for cervical dystonia or death from that condition (s5, s8, Schedule 1).

This SOP does not itself impose statutory duties on private parties or create substantive entitlements. Instead it prescribes medical nexus factors that decision makers must apply when determining service connection under the VEA and MRCA. The “duties” and “rights” that flow from the instrument are therefore operational and evidentiary rather than punitive or prescriptive.

Duty to establish a nexus factor

• Before an adjudicator can decide, on the balance of probabilities, that cervical dystonia is connected with relevant service, a claimant must establish at least one of the factors listed in section 9, here the inability to obtain appropriate clinical management before clinical worsening (s9(1)). The SOP therefore creates an evidentiary requirement: the decision maker is not permitted to find connection under this SOP unless a listed factor exists (s9 introductory sentence).

Duty to relate factors to relevant service

• The instrument expressly requires that any factor relied upon must be related to the person’s relevant service (s10(1)). Thus a claimant’s proof must not only show the existence of the factor but also demonstrate a causal or associative link between that factor and the person’s service as defined in Schedule 1.

Limitation on applicability of the s9(1) factor

• Section 10(2) imposes a further restriction: the s9(1) factor applies only to a material contribution to, or aggravation of, cervical dystonia where the person’s dystonia was suffered or contracted before or during, but did not arise out of, the person’s relevant service. Practically, that means the s9(1) pathway is intended for cases of pre‑existing dystonia aggravated by service, not for dystonia that originated as a consequence of service. The decision maker must be satisfied about the timing and causal categories set out in s10(2) before applying s9(1).

Right to rely on other SOPs where cross‑references exist

• If a factor in s9 refers to an injury or disease covered by another SOP, the instrument requires that the factors in that other SOP apply in accordance with its terms (s11). This gives claimants and decision makers a right to rely on the content of other SOPs when cross‑reference occurs; it also imposes a duty on decision makers to consult and apply the other SOP as it stands.

Diagnostic boundaries and exclusions

• The SOP’s definition of cervical dystonia sets explicit boundaries for what is and is not within the SOP’s scope (s7(2)). A right to have a claim assessed under this SOP depends on the claimant’s condition falling within the textual definition. If the claimant’s dystonia is drug‑induced or due to a structural brain lesion, the instrument excludes it from this SOP.

Standard of proof

• The instrument is framed by the “balance of probabilities” standard. The RMA states it is of the view, on the sound medical‑scientific evidence available, that it is more probable than not that cervical dystonia and death from it can be related to relevant service (s8). For claimants, the practical consequence is that decision makers will apply the balance of probabilities to the nexus question using the SOP’s factors.

Procedural and substantive limits

• The SOP does not itself determine entitlement, quantum, medical treatment obligations, nor does it prescribe the procedural steps for how claims should be made or reviewed; those rights and duties remain determined under the VEA and MRCA statutory frameworks and implementing procedures. The SOP’s role is to supply the medical nexus criteria (s3, s5). The instrument contains no penalty or enforcement clauses (see Penalties and enforcement below).

The instrument contains no criminal, civil or administrative penalties and does not create enforcement mechanisms. It is a medical statement of factors to be used by decision makers in statutory claims under the VEA and MRCA. The authority for the instrument is subsection 196B(3) of the VEA (s3), which empowers the Repatriation Medical Authority to determine SOPs; this instrument exercises that power but does not itself set out sanctions or enforcement powers.

What the instrument does for enforcement and review is implicit and limited

• The SOP provides a standard that decision makers must apply when adjudicating whether cervical dystonia or death from it is connected with relevant service under the applicable statutory provisions (s5, s8). Enforcement, in the sense of ensuring adherence to the SOP, will therefore be achieved through the internal and statutory decision making under the VEA and MRCA. The instrument does not prescribe the internal administrative processes, review pathways, or appeals mechanisms of those Acts. Any review or appeal rights remain those conferred by the VEA and MRCA, not by this SOP.

No express investigative or monitoring powers

• The SOP contains no provision that gives inspectors, RMA staff or other officials investigatory powers to compel medical records, order examinations, or impose compliance notices. Where evidence is required to show that a factor exists, obtaining that evidence will be done within the normal evidentiary and administrative frameworks governing VEA and MRCA claims; the SOP itself is silent about the process for obtaining records.

Consequences of non‑compliance with evidentiary requirements

• Because the SOP establishes the evidential standard by listing the factors that must exist to establish nexus, the practical enforcement consequence is that a claimant who cannot establish a listed factor will not succeed in proving connection under this SOP. That consequence is a function of the statutory decision making under the VEA/MRCA and not a new penalty inserted by this instrument.

Record of repeal but no retroactive enforcement mechanism

• The instrument repeals the earlier SOP No. 64 of 2016 (s4). It does not provide transitional enforcement provisions, nor does it state whether or how decisions made under the repealed SOP should be revisited. The absence of transitional directions is an implementation feature to note for administrative practice but does not itself impose penalties.

In sum, the instrument is an evidentiary and definitional tool used in the decision making process. It contains no standalone penalties or enforcement provisions; consequences flow from the MDT application of its factors within the VEA/MRCA statutory and administrative processes.

This SOP operates within, and expressly for the purpose of, the VEA and MRCA claim frameworks. Its inter‑legal interactions are limited and defined in the text.

Authority and statutory anchoring

• The instrument is made under subsection 196B(3) of the VEA (s3). It applies to claims to which section 120B of the VEA or section 339 of the MRCA apply (s5). That anchoring makes it part of the RMA’s suite of SOPs that decision makers use in applying the VEA and MRCA. The SOP itself does not amend the VEA or MRCA; rather it supplies medical criteria used under those Acts.

Interaction with other SOPs

• Section 11 provides that if a factor in this SOP refers to an injury or disease for which another SOP has been determined under subsection 196B(3) of the VEA, then the factors in that other SOP apply in accordance with its terms as in force from time to time. This creates a forward‑looking cross‑SOP mechanism: where the nexus factor invokes another condition that already has an SOP, decision makers must consult and apply that other SOP. The instrument therefore does not operate in isolation where cross‑references arise; it explicitly defers to the content of other SOPs.

Coding and international classification reference

• The SOP records that cervical dystonia attracts ICD‑10‑AM code G24.3, and it identifies the specific edition and effective date of the ICD‑10‑AM referenced (Tenth Edition, effective date 1 July 2017) (s7(3)). However, the SOP also makes clear that, for the purposes of applying the SOP, the statutory textual definition in subsection 7(2) controls. Thus, while the SOP intersects with the ICD classification system for diagnostic coding, the SOP’s legal meaning is the text in subsection 7(2) rather than the code alone.

Interaction with definitions of relevant service and MRCA/VEA

• The Schedule defines “relevant service” for the purposes of the SOP. That definition is not the generic statutory definition from elsewhere; instead it lists three categories: 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 (Schedule 1). The SOP therefore imports categories that interact with underlying definitions in the VEA and MRCA and restricts the types of service to which its factors can be related.

Replacements and repeal

• The SOP expressly repeals the prior Statement of Principles concerning spasmodic torticollis No. 64 of 2016 (s4). That repeal interacts with past claim decisions to the extent that decision makers will now apply the new SOP in place of the old one going forward. The instrument, however, does not set out transitional provisions that would expressly govern past decisions; the way that repeal interacts procedurally with existing decisions will be governed by the VEA/MRCA and administrative practice rather than by this instrument.

No express conflict resolution clause

• The instrument does not include a clause resolving conflicts between it and other legislative provisions. Its operation is as a RMA medical statement used under the statutory decision making framework of the VEA and MRCA. Where questions arise about inconsistencies, the underlying Acts and administrative law principles will govern resolution; the SOP itself does not address conflict or supremacy questions.

In short, the SOP is a focused medical evidence instrument that plugs into the VEA and MRCA scheme, defers to other RMA SOPs where referenced, and references diagnostic classification systems while making its own textual definition controlling for legal purposes (s3, s5, s7(3), s11, Schedule 1).

The instrument contains limited explicit amendment history within its text. The available history elements are:

• New instrument creation and dates: The instrument is dated 15 April 2025 and expressly states its commencement date as 19 May 2025 (s1 header, s2). The dating indicates the RMA adopted the SOP on 15 April 2025 and set the coming into force date.

• Repeal of prior SOP: Section 4 expressly repeals the earlier Statement of Principles concerning spasmodic torticollis No. 64 of 2016, identified by its Federal Register of Legislation number F2016L01139. That repeal is a discrete amendment act: it removes the older SOP from the corpus of RMA SOPs and replaces it with this new instrument (s4).

• No other amendments recorded: The instrument does not record any other amendments, revisions, or historical changes to its text. It contains no "as amended" history listing, no amendment schedule, and no transitional provisions dealing with how ongoing claims are to be treated on repeal of the earlier SOP. The text therefore stands as a single, self‑contained instrument replacing the 2016 SOP from its commencement date (s2, s4).

• Cross‑SOP updates implicit: Section 11 contemplates that other SOPs may be applied as in force from time to time where cross‑references occur. This introduces an implicit, ongoing amendment interaction: when other SOPs are amended in future, their terms as in force will be applied where s11 cross‑reference arises. The instrument itself does not track or list those amendments; it simply defers to the current text of other SOPs at the time of application (s11).

What the instrument does not say about amendment history

• It contains no schedule of prior drafts, no record of consultations, and no legislative history of changes to the definition or to the list of factors. It does not set out whether the repeal of the 2016 SOP will be applied retrospectively or whether decisions made under the earlier SOP are to be revisited. Practitioners should therefore assume that the new SOP replaces the earlier SOP for claims determined after the commencement date, but the SOP itself does not provide explicit transitional guidance (s2, s4).

For compliance and administrative planning, the concrete amendment history relevant to users is therefore the repeal of the 2016 SOP and the coming into force of this 2025 SOP on 19 May 2025. Any further amendment history must be read from later instruments or from the Federal Register where future SOPs or amendments are published.

The instrument contains no judicial decisions, case references, or litigation history. It is a determinative administrative instrument created under subsection 196B(3) of the VEA and does not record any court proceedings or adjudicative rulings about its interpretation, scope or validity. The text itself lists no cases and makes no reference to any litigation (full instrument text).

Practical implications for potential litigation

• Because the SOP establishes a narrow medical nexus pathway, disputes that might lead to litigation or review under the VEA or MRCA administrative frameworks are likely to turn on questions of statutory interpretation and factual application of the SOP’s clauses. These would include:

  • Whether a claimant’s diagnosis falls within the positive definition in subsection 7(2) and is not excluded by any of the listed exclusions.
  • Whether the claimant can establish the existence of the factor in section 9, namely inability to obtain appropriate clinical management for cervical dystonia before clinical worsening.
  • Whether any such factor is sufficiently related to the claimant’s relevant service as required by section 10(1).
  • For aggravation or material contribution cases, whether the dystonia was suffered or contracted before or during, but did not arise out of, the relevant service as required by section 10(2).
  • For death claims, whether a terminal event (as defined in the Schedule) was contributed to by cervical dystonia.

• Challenges may therefore feature contested medical evidence and competing expert reports focusing on diagnosis, timing, clinical management history, and causal linkage to service. The SOP’s text frames these matters but does not prescribe the administrative evidentiary procedure; appeals and judicial review would occur under the statutory review mechanisms of the VEA and MRCA and general administrative law principles rather than under the SOP itself.

Absence of precedent in the instrument

• Because the SOP does not itself record litigation, readers must look to decisions under the VEA and MRCA, tribunal or court determinations, and RMA practice statements for any precedent that interprets similar SOPs or addresses analogous factual questions. The instrument does not supply or summarise that body of law.

In short, the SOP has no internal litigation history. The kinds of disputes that could generate litigation can be anticipated from the textual knots in the instrument, but any actual litigation or judicial interpretation must be identified from external records, which this instrument does not provide.

The SOP’s brevity and targeted drafting create several concrete risks and potential pitfalls practitioners should be alert to when preparing or opposing claims.

Narrow diagnostic boundary and explicit exclusions (s7(2))

• The statutory definition of cervical dystonia in subsection 7(2) both defines the condition and lists seven explicit exclusions. A claimant whose dystonia is drug‑induced, part of a generalised dystonia syndrome, paroxysmal, congenital, secondary to a neurological disorder, due to a structural lesion of brain or cervical cord, or due to a local lesion of the cervical region is excluded from being assessed under this SOP. Practitioners must therefore ensure the medical evidence speaks directly to these exclusions. A diagnostic label alone, or reliance solely on an ICD code, will not suffice because the SOP’s textual definition controls (s7(3)).

Single listed factor with particular wording (s9(1))

• The SOP contains only one listed factor: “inability to obtain appropriate clinical management for cervical dystonia (spasmodic torticollis) before clinical worsening.” The wording requires careful unpacking in evidence. Does “inability to obtain” mean lack of available services, denial of access, financial inability, or failure of the health system? The SOP does not define the term, so medical reports and administrative decision makers will need to establish the factual basis for the claimed inability. Practitioners should anticipate that adjudicators will look for contemporaneous records showing attempts to obtain clinical management, referrals, waitlist evidence, or service‑related denial of access.

Temporal and causal restriction for the s9(1) factor (s10(2))

• Section 10(2) is a significant and potentially unexpected constraint. It states that the factor in s9(1) applies only to material contribution to, or aggravation of, cervical dystonia where the person’s dystonia was suffered or contracted before or during, but did not arise out of, the person’s relevant service. Put plainly, s9(1) is structured for pre‑existing or pre‑contracted dystonia aggravated by service, not for dystonia that originated in service. This is a key “gotcha”: if the claimant’s dystonia arose out of service, the s9 pathway does not apply and claimants must rely on other nexus reasoning or another SOP. Establishing when the dystonia was first suffered or contracted will therefore be critical and possibly contested.

Requirement that any factor be related to relevant service (s10(1))

• The SOP requires that the existence of any factor in s9 be related to relevant service. The Schedule defines “relevant service” narrowly and excludes some forms of service (Schedule 1). Practitioners must ensure evidence links the inability to obtain management to the person’s relevant service as the Schedule defines it. For example, general civilian care deficiencies that have no nexus to service may not satisfy the relationship requirement.

Death claims require contribution to a terminal event (s7(4); Schedule 1)

• For death claims, the SOP covers death from a terminal event or condition that was contributed to by the person’s cervical dystonia. The Schedule lists examples of terminal events such as pneumonia and respiratory failure. The “contributed to” standard requires medical evidence tying the dystonia to the terminal event; assertion alone will be insufficient. Practitioners should ensure that autopsy reports, hospital records and treating notes address the causal contribution.

ICD code is not determinative (s7(3))

• The SOP mentions the ICD‑10‑AM code G24.3 but says the SOP meaning is the textual definition in subsection 7(2). Relying solely on an ICD code in clinical records without mapping that diagnosis to the SOP’s definition and exclusions risks an adverse decision.

No transitional guidance on repeal (s4)

• The instrument repeals the 2016 SOP but contains no transitional provisions. Practitioners should not assume automatic retrospective application or preservation of prior decision outcomes. The SOP is silent on how pending or previously accepted claims are to be treated; administrative practice under the VEA and MRCA will determine the approach, not this instrument.

Cross‑SOP referrals (s11)

• If the s9 factor refers to an injury or disease covered by another SOP, that other SOP applies as in force. This can create a practical complexity: the applicable nexus pathway may involve an interplay of SOPs, and the controlling text for a particular element of causation might be in a different instrument. Practitioners should trace cross‑references carefully.

Evidentiary burden and documentary proof

• The SOP’s text implies an evidentiary burden on claimants to establish a factor exists and is service related. Because the instrument does not prescribe evidentiary standards or procedures, claimants should prepare robust documentary proof. Absence of specific procedural guidance is a practical trap: without contemporaneous records proving attempts to obtain treatment and linking service circumstances to the inability to obtain care, claimants are likely to struggle.

In short, the combination of a single, narrowly phrased factor, strict temporal and causation limitations, and explicit exclusions makes the SOP a document where small differences in factual proof can determine outcomes. Practitioners should read the definitions and the relationship clauses closely and structure evidence to address each textual requirement.

For claimants, clinicians and advisers preparing a claim under the VEA or MRCA involving cervical dystonia or death from cervical dystonia, compliance means assembling and presenting evidence that corresponds precisely to the elements the SOP sets out. The key compliance tasks are set out below, with references to the relevant provisions.

1. Confirm the diagnosis fits the SOP definition (s7(2))

• Obtain medical records and specialist reports that describe the clinical features required by subsection 7(2)(a): chronic focal dystonia with sustained or intermittent involuntary neck muscle contractions causing repetitive movements or abnormal movements or postures of the head, neck, and shoulders.
• Have clinicians explicitly address the seven exclusions listed in subsection 7(2)(b). Where the treating clinician rules out drug‑induced dystonia, generalised dystonia, paroxysmal or congenital forms, dystonia due to neurological disorders, structural lesions or local cervical lesions, ask for that to be stated in the report and supported by investigation results (imaging, medication history, neurology notes).

2. If claiming death was connected to cervical dystonia, show contribution to a terminal event (s7(4) and Schedule 1)

• For death claims, obtain hospital discharge summaries, coroner’s findings, autopsy reports and treating clinician statements that address whether the terminal event (for example pneumonia, respiratory failure or cardiac arrest) was contributed to by the decedent’s cervical dystonia.
• Ensure the medical evidence explicitly links the dystonia to the terminal event in causal terms, not only by temporal coincidence.

3. Establish the s9(1) factor: inability to obtain appropriate clinical management before clinical worsening (s9(1))

• Document attempts to obtain clinical management: referrals, appointment booking records, correspondence with providers, evidence of service‑related impediments to access, and clinical notes noting lack of treatment.
• Define what “appropriate clinical management” meant in the person’s case: botulinum toxin therapy, physiotherapy, specialist neurology follow‑up, surgery, or other recommended interventions. Have treating specialists set out what appropriate management would have been and whether it was available or received.
• Provide contemporaneous clinical notes that demonstrate clinical worsening occurred after the period in which management could not be obtained, to establish the “before clinical worsening” timing element.

4. Tie the factor to relevant service (s10(1) and Schedule 1)

• Show how the inability to obtain management is related to the person’s relevant service as defined in the Schedule. Gather service records, military medical records, locations of postings, periods of service, and other documents that show a nexus between the service circumstances and the inability to access care.
• Confirm the category of relevant service that applies for the claimant: eligible war service (other than operational service), defence service (other than hazardous service and British nuclear test defence service) under the VEA, or peacetime service under the MRCA (Schedule 1). Ensure the evidence demonstrates the person’s service falls within one of these categories.

5. Pay attention to the timing restriction for material contribution or aggravation (s10(2))

• If relying on s9(1) as a basis for material contribution or aggravation, the claimant must show the dystonia was suffered or contracted before or during, but did not arise out of, the relevant service. This requires clear medical and service timelines. Collect diagnostic dates, onset histories, pre‑service medical records if available, and service medical records showing continuity.
• If the dystonia appears to have arisen out of service (i.e. originated because of service), s9(1) will not apply. Counsel and clinicians should consider whether a different SOP or a different nexus argument is appropriate.

6. Address ICD coding but prioritise textual mapping (s7(3))

• While referencing ICD‑10‑AM code G24.3 (Tenth Edition, effective 1 July 2017) may be useful, ensure all documentary medical evidence maps the clinical features to the SOP’s textual definition in subsection 7(2). Do not rely exclusively on diagnostic codes.

7. Where s9 refers to other injuries or diseases, check for cross‑SOP application (s11)

• If the s9 factor invokes another injury or disease that has its own SOP, obtain and mobilise the other SOP’s factors as they stand. Ensure that medical reports also address those SOP criteria, because s11 requires applying the other SOP in accordance with its current terms.

8. Prepare for challenged evidentiary foundations

• Because the SOP does not specify procedural rules, expect decision makers to scrutinise the factual foundation. Compile robust contemporaneous evidence demonstrating attempts to access care, provider refusals, waitlists, geographic unavailability, or service‑linked impediments to clinical access. If records are incomplete, obtain sworn affidavits from treating clinicians and where feasible from the claimant about attempts to obtain care, and explain gaps.

9. Be mindful of repeal and commencement dates (s2, s4)

• For claims lodged or determined around the transition between the repealed 2016 SOP and this 2025 SOP, check administrative guidance and decision dates. The instrument commences on 19 May 2025 and repeals the 2016 SOP; the instrument itself contains no transitional provisions. Practitioners should confirm with claims administrators which SOP applies to a particular claim decision date.

10. Structure expert opinions to mirror SOP language

• Ask clinicians and expert witnesses to address the SOP elements explicitly in their reports: diagnosis mapped to s7(2), exclusion analysis against s7(2)(b)(i)-(vii), a clear expert opinion on whether inability to obtain appropriate clinical management occurred and whether it preceded clinical worsening (s9(1)), and an opinion on how, in their view, the inability to obtain care was related to relevant service (s10(1)). For aggravation opinions under s10(2), experts should state when the dystonia was first suffered or contracted.

By organising evidence to align directly with the SOP’s text, claimants and their advisers reduce the risk that decision makers will dismiss claims on technical mismatch. The SOP sets a legal framework for medical nexus: compliance is achieved by constructing a chain of documentary and expert medical evidence that directly addresses each textual element the SOP requires.