Statement of Principles concerning cervical dystonia (spasmodic torticollis) (Reasonable Hypothesis) (No. 41 of 2025)

Definition of the condition: The instrument defines cervical dystonia (spasmodic torticollis) for its purposes as a chronic focal dystonia characterised by sustained or intermittent involuntary neck muscle contractions causing repetitive movements or abnormal postures of the head, neck, and shoulders (s 7(2)(a)). It then lists exclusions which are part of the definition: 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 (s 7(2)(b)(i)-(vii)). The instrument notes that, although ICD‑10‑AM code G24.3 applies to cervical dystonia, the statutory meaning for claims is the statutory definition in s 7(2) (s 7(3)-(4)). The Schedule clarifies that references to ICD‑10‑AM use the Tenth Edition effective 1 July 2017 (Schedule 1, definition in s 1(3)).

Death and causation approach: The Statement treats "death from cervical dystonia" as including death from a terminal event or terminal condition that the dystonia contributed to (s 7(6)). The Schedule defines "terminal event" by example, listing pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (Schedule 1). This makes clear that death claims may be assessed where one of those proximate causes was contributed to by the dystonia.

Evidentiary gateway: The instrument prescribes the minimum factor(s) that must exist before a reasonable hypothesis can be said to be raised connecting the condition (or death) with relevant service (s 9). The gateway requires at least one of two listed factors. The first factor (s 9(1)) is trauma to the neck, head or shoulders producing local symptoms that last at least two weeks and that occurred within the year before clinical onset. The instrument lists example mechanisms of trauma (motor vehicle accidents, whiplash, assault, falls, heavy lifting) as a note to the factor (s 9(1) Note). The second factor (s 9(2)) is an inability to obtain appropriate clinical management for cervical dystonia before clinical worsening.

Relationship to service: The Statement makes explicit that any factor relied upon must be related to the person’s relevant service (s 10(1)). The Schedule sets out the categories of "relevant service" that trigger application of the instrument: operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike or non‑warlike service under the MRCA (Schedule 1). The instrument places a specific constraint on the second factor: subsection 9(2) applies only as a basis for material contribution to, or aggravation of, cervical dystonia where the person’s condition was suffered or contracted before or during (but did not arise out of) their relevant service (s 10(2)).

Interaction with other Statements of Principles: If a listed factor refers to an injury or disease that is the subject of another Statement of Principles made under subsection 196B(2) of the VEA, the instrument instructs that the factors in that other Statement apply in accordance with its terms as in force from time to time (s 11). This creates an explicit cross‑reference mechanism for overlapping medical causes or causal pathways.

Administrative form and scope: The instrument is made by the Repatriation Medical Authority, signed on behalf of the Authority by the Chairperson (cover sheet) and dated 15 April 2025. It applies to claims to which s 120A of the VEA or s 338 of the MRCA apply (s 5), and it replaces the prior Statement No. 63 of 2016 (s 4). The Authority expressly states a view that there is sound medical‑scientific evidence linking the condition and death from the condition to relevant service (s 8); that is an administrative statement of scientific basis, not a statutory rule of causation beyond the listed factors.

Direct legal actors: The primary immediate users of this instrument are decision-makers who assess claims under the VEA and the MRCA. The instrument expressly applies to claims to which section 120A of the VEA or section 338 of the MRCA apply (s 5). Those decision-makers will use the Statement as the authoritative list of medical factors and definitions for deciding whether a reasonable hypothesis connects cervical dystonia or death from it with relevant service.

Claimants: Persons lodging claims under the relevant sections of the VEA or MRCA are affected because the demonstrable presence of at least one of the factors in section 9, related to their relevant service, is prescribed as the threshold to raise a reasonable hypothesis of service connection (s 9, s 10). The instrument therefore changes what evidence claimants must present to meet the statutory evidentiary gateway implicit in the claims process. It also affects dependants or estates in death claims because death from the condition is given a specific definition that includes terminal events contributed to by the dystonia (s 7(6); Schedule 1 definition of "terminal event").

Veterans, members of Peacekeeping Forces and members of the Forces under the VEA or MRCA: The instrument is expressly framed around relevant service, which the Schedule defines to include operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike or non‑warlike service under the MRCA (Schedule 1). That means individuals who served in any of those capacities and who later develop the condition (or whose death may have been contributed to by it) are within scope for assessment under this Statement when they make claims.

The Repatriation Medical Authority: The Authority itself is the decision‑maker for issuing the Statement and for repealing the prior Statement No. 63 of 2016 (s 3, s 4). The RMA’s formal view on the medical‑scientific basis is recorded in the instrument (s 8); the Authority therefore performs the technical role of setting the medical parameters to be applied across claims.

Health professionals and record keepers: While not explicitly named as regulated parties, clinicians and hospitals are indirectly affected because the content of clinical records , including documentation of trauma, symptom duration, timing of clinical onset, and evidence of attempts to obtain appropriate clinical management , become the primary materials claimants will need to adduce to meet the condition the Statement sets for raising a reasonable hypothesis (s 9). The instrument also references ICD‑10‑AM coding (s 7(4)), so coders may note the relationship between the clinical nomenclature and the statutory definition.

Excluded persons or conditions: The defined meaning excludes a number of categories of dystonia (s 7(2)(b)). Persons whose dystonia is drug‑induced, part of a generalised or hemidystonia, paroxysmal, congenital, due to a neurological disorder, due to a structural brain or cervical cord lesion, or a local cervical lesion are outside the Statement’s statutory definition for the purposes of claims under this instrument. Claimants with those causes will not have their condition treated as "cervical dystonia (spasmodic torticollis)" under this instrument and will need to rely on other Statements or other legal pathways if available.

Indirect administrative actors: Agencies responsible for adjudicating VEA or MRCA claims, medical officers within those agencies, and legal advisers acting for either claimants or the Department will be affected in that they must apply the new Statement from its commencement date and consider the repealed earlier Statement’s removal (s 2, s 4).

What the instrument requires of decision-makers: The Statement prescribes the medical criteria and factors that must exist to raise a reasonable hypothesis that the condition or death from it is related to relevant service (s 9). Decision-makers applying s 120A of the VEA or s 338 of the MRCA must therefore use this instrument as the governing Statement of Principles for claims that fall within its scope (s 5). The instrument requires that any factor relied upon be related to the person’s relevant service (s 10(1)). Where a factor refers to another injury or disease for which a separate Statement exists, decision-makers are required to apply the factors in that other Statement in accordance with its own terms (s 11). The instrument also imposes a specific interpretive limit on the second factor (inability to obtain appropriate clinical management): section 10(2) restricts the application of the subsection 9(2) factor to circumstances in which the person’s cervical dystonia was suffered or contracted before or during, but did not arise out of, the relevant service, and only where the inability to obtain management materially contributed to or aggravated the condition.

What the instrument changes for claimants: While the instrument does not itself create statutory entitlements or enumerate procedural claim rights, it is a binding evidentiary instrument for the relevant claims. This means claimants must satisfy the threshold the Authority has set to raise a reasonable hypothesis if they want their condition or death to be treated as possibly service‑connected under the specified VEA and MRCA claim provisions (s 5, s 9). Practically that means claimants ought to produce evidence of either (a) qualifying trauma to the neck, head or shoulders with local symptoms of at least two weeks’ duration within the year before clinical onset, or (b) that they were unable to obtain appropriate clinical management before clinical worsening, and also show that the relevant factor is related to their relevant service (ss 9-10).

Burden of proof and rights language: The instrument uses the phrase "reasonable hypothesis" and specifies the factors that will satisfy the threshold for a reasonable hypothesis to be raised (s 9). The instrument does not itself specify the ultimate standard of proof for establishing service connection for entitlement purposes, nor does it alter statutory decision-making processes in the VEA or the MRCA beyond supplying the medical criteria. The Authority’s statement that there is "sound medical‑scientific evidence" for a relationship (s 8) is an express administrative position about the scientific basis; the instrument does not convert that into an automatic entitlement absent the factual matrix and the claims process applicable under the VEA and MRCA.

Administrative duty to consider other Statements and ICD coding: Decision-makers must apply other Statements when a factor refers to another injury or disease (s 11). The instrument notes the ICD‑10‑AM code G24.3 applies to cervical dystonia but makes clear the statutory meaning is the definition in s 7(2) (s 7(3)). The Schedule specifies which edition of ICD‑10‑AM is referenced (Tenth Edition, effective 1 July 2017) (Schedule 1). These textual cross-references are duties on decision-makers to interpret medical material in light of both statutory definition and clinical coding conventions.

No penalties or criminal duty imposed: The instrument does not create offences, penalties or direct enforcement mechanisms. It is an administrative Statement intended to be used in claim assessment. The instrument imposes no sanction for non-compliance within its own text.

Who decides and who certifies: The Repatriation Medical Authority determines the Statement (s 3) and records its view on the medical‑scientific evidence (s 8). Decision-makers applying the VEA and MRCA will be the bodies who use the Statement in deciding claims; the instrument does not itself name the adjudicators in the claims process but ties its application to specific statutory claim provisions (s 5).

This Statement of Principles contains no penalties, fines, criminal offences, or civil enforcement provisions in its text. It is an administrative determinative instrument that provides medical parameters for claims purposes under the VEA and the MRCA. The instrument does not prescribe enforcement mechanisms or sanctions for non-compliance because its function is to define medical factors and their relationship to relevant service for claim assessment (see ss 3-5, 7-11).

Consequences in the claims process: Although the Statement itself imposes no penalties, its application can produce practical enforcement‑style effects within the VEA/MRCA claims systems. Specifically, a decision-maker assessing a claim within the scope of s 120A of the VEA or s 338 of the MRCA will rely on this Statement as the authoritative list of factors for raising a reasonable hypothesis linking cervical dystonia (or death from it) to relevant service (s 5, s 9). If the claimant cannot establish at least one of the enumerated factors related to relevant service, the decision-maker may find that a reasonable hypothesis is not raised and may reject the claim on that basis. The instrument therefore functions as an evidentiary gate in administrative decision-making, with potential downstream consequences for entitlement, but those consequences derive from the adjudicatory process under the VEA or MRCA rather than from this Statement itself.

Administrative reconciliation and repeal: The instrument repeals the prior Statement No. 63 of 2016 (s 4). Decision-makers and claimants must therefore apply this Statement from its commencement date and not the repealed instrument. The practical enforcement task for agencies is to ensure that claims lodged after the commencement use the current Statement; agencies will need to update internal guidance and workflows to reflect the change.

Interaction with other legal mechanisms: The instrument requires decision-makers to apply other Statements of Principles where a factor refers to an injury or disease covered by another Statement (s 11). That cross‑application is itself an enforcement mechanism of a sort, in that it mandates the use of an additional Statement’s factors as part of the causation enquiry. The Statement does not, however, provide a mechanism for resolving disputes about interpretation of the other Statements; such disputes remain within the broader administrative and judicial review landscape of VEA/MRCA decision-making.

No explicit monitoring or reporting obligations: The text contains no provision for review periods, reporting requirements, or administrative monitoring of the Statement’s operation. The Authority records its view on the medical‑scientific basis (s 8), but the Statement does not prescribe how or when that view should be reviewed or updated.

Statutory basis and applicable claim provisions: The Statement is made under subsection 196B(2) of the VEA (s 3). It expressly applies to claims to which section 120A of the VEA or section 338 of the MRCA apply (s 5). That places this instrument within the statutory framework of the VEA and MRCA claims regimes, and its legal operation is as an evidentiary instrument to be applied by decision‑makers in those statutory contexts. The instrument does not itself amend the VEA or MRCA; rather it functions under the statutory power to make Statements of Principles.

Interaction with other Statements of Principles: The instrument contains a direct cross‑reference rule. Where a factor in section 9 applies and that factor refers to an injury or disease which is the subject of another Statement of Principles made under subsection 196B(2) of the VEA, the factors in that other Statement "apply in accordance with the terms of that Statement as in force from time to time" (s 11). This creates a hierarchical interpretive rule: decision-makers must consult and apply other relevant Statements where a factor expressly refers to a different injury or disease. The application of such other Statements is governed by their own terms and any subsequent amendments to them.

ICD‑10‑AM coding reference: The instrument notes that cervical dystonia attracts ICD‑10‑AM code G24.3, but that when applying the Statement the meaning is the statutory definition in s 7(2) (s 7(3)). The Schedule clarifies that a reference to an ICD‑10‑AM code is to the Tenth Edition effective 1 July 2017 (Schedule 1). This establishes a nominal link to clinical coding conventions while clarifying that the statutory definition controls for claims purposes.

Effect on prior Statement and transitional considerations: The instrument explicitly repeals the earlier Statement No. 63 of 2016 (s 4). The repeal suggests that claims which would have previously been assessed under the 2016 Statement are to be assessed under this instrument from its commencement date, although the text does not itself state transitional rules. Decision-makers will need to treat the prior instrument as no longer in force after repeal and apply the new Statement to relevant claims within the statutory claims processes under the VEA/MRCA.

No modification of entitlement rules: The Statement does not alter the substantive entitlement provisions of the VEA or the MRCA. It provides medical criteria relevant to the causation enquiry that decision-makers use when deciding claims under the cited statutory claim provisions (s 5). Changes to eligibility, rates, or procedural rights within the VEA or MRCA are not addressed in this text.

Relationship to medical law and clinical practice: The Authority records that it is of the view there is "sound medical‑scientific evidence" that the condition and death from the condition can be related to relevant service (s 8). The Statement then specifies the clinical factors and temporal requirements (s 9). Clinicians’ diagnoses and records remain the source of factual material for claimants and adjudicators, but the instrument governs which clinical facts are legally material when determining whether a reasonable hypothesis is raised.

Limitations on scope with respect to excluded causes: The statutory definition in s 7(2) expressly excludes several aetiological categories of dystonia. Those exclusions mean that where the clinical cause is, for example, a structural brain lesion or drug-induced dystonia, a claimant cannot rely on this Statement’s factors to raise a reasonable hypothesis in relation to cervical dystonia as defined here. Such claims will need to be considered under other relevant Statements or legal pathways if available.

Creation and dates: The Statement is identified as No. 41 of 2025 and is dated 15 April 2025 on the instrument (cover page). It commences on 19 May 2025 (s 2). The Repatriation Medical Authority is the issuing body (s 3).

Repeal of prior instrument: The Statement expressly repeals the Statement of Principles concerning spasmodic torticollis No. 63 of 2016 made under subsection 196B(2) of the VEA, with the repealed instrument identified by Federal Register of Legislation number F2016L01136 (s 4). The text contains no transitional provisions; the repeal is stated as operative in the instrument.

Authority for amendments: The instrument is made under subsection 196B(2) of the VEA (s 3). Any future amendments to this Statement would similarly be expected to occur under the Authority’s powers in that subsection, though the instrument itself does not list the amendment mechanism beyond its express statutory authority.

Versioning and cross-references: Section 11 instructs that if a factor refers to an injury or disease covered by another Statement, the factors in that other Statement "apply in accordance with the terms of that Statement as in force from time to time" (s 11). That language explicitly recognises that other Statements can be amended independently and that this Statement’s operation may consequently vary in practice as other Statements change. The instrument therefore anticipates and allows for the changing landscape of other Statements.

No internal amendment schedule included: The Statement does not include internal amendment triggers, review dates, or sunset clauses. The text records the Authority’s current view on the medical‑scientific evidence (s 8) but provides no formal mechanism for periodic automatic review or mandated reporting about future changes.

Document metadata: The cover sheet identifies Professor Terence Campbell AM as Chairperson signing on behalf of the Repatriation Medical Authority. The instrument contains a Schedule (Schedule 1) providing definitions that form part of the instrument. Together these elements form the complete instrument as of the commencement date.

The instrument itself names no cases and includes no account of judicial decisions. The text provides neither a litigation history nor references to judicial interpretation of the present Statement or its predecessor. The only procedural history contained in the instrument is administrative: the date of making (15 April 2025), the date of commencement (19 May 2025), and the express repeal of the earlier Statement No. 63 of 2016 (s 2, s 4). Because the instrument is a fresh Statement replacing the 2016 Statement, any litigation that engages the present instrument will, going forward, involve questions about the interpretation and application of the current text and its factors, but the instrument provides no record of such litigation.

Implications for legal challenges: The Statement prescribes subjective elements such as the "reasonable hypothesis" threshold and lists specific factual factors that must be present to raise that hypothesis (s 9). Courts typically review administrative decisions for legality, rationality, and compliance with statutory requirements, but the instrument itself does not canvass past decisions or anticipated litigation lines. Readers must therefore treat the absence of litigation material in the instrument as neutral: the instrument stands on its text and the statutory scheme under which it is made.

Predecessor instrument: The statutory repeal of the 2016 Statement (s 4) means that any litigation that relied on the 2016 criteria will now have to be re‑assessed in light of this new Statement where claims fall within its commencement. The instrument does not set out how decisions made under the repealed Statement are to be treated post-repeal; that is left to the operation of the VEA/MRCA claims processes and any applicable transitional or savings provisions found elsewhere in the statutes or regulations.

No named case law or interpretive guidance: Practitioners seeking precedents or interpretive guidance specific to this Statement will need to look beyond the instrument to decisions applying this instrument after its commencement or to jurisprudence on comparable Statements of Principles. The instrument itself contains no interpretive notes beyond the statutory text, the Schedule of definitions, and a short list of notes (for example, mechanisms of trauma listed as examples in s 9(1) Note).

Narrow statutory definition and exclusions: The instrument’s definition of cervical dystonia (s 7(2)) includes explicit exclusions: 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 (s 7(2)(b)(i)-(vii)). A diagnosis that falls within any of those excluded categories will not be treated as "cervical dystonia (spasmodic torticollis)" for the purposes of this Statement, even if clinical coding might otherwise classify it under ICD‑10‑AM. Practitioners must therefore check whether the clinical aetiology falls within an exclusion before relying on this Statement.

Strict temporal and symptom-duration requirement for trauma factor: The first factor requires trauma to the neck, head, or shoulders that produces "local symptoms lasting for at least 2 weeks, within the 1 year before clinical onset" (s 9(1)). There are three discrete temporal elements to be satisfied: (a) trauma occurred; (b) local symptoms lasted at least two weeks; and (c) those symptoms occurred within one year before clinical onset. Failure to establish either the symptom duration or the one-year window will mean that factor does not satisfy the instrument’s test. Practitioners must ensure clinical records can substantiate symptom onset dates, duration, and relation to trauma.

Ambiguity of "clinical onset" and proof of timing: The instrument uses the phrase "clinical onset" (s 9(1)) without defining it further. That leaves room for disputes about how to date clinical onset in practice. Is "clinical onset" the first documented presentation, the first symptom recollection, or the first diagnosis? The instrument does not clarify, so evidence to support a claimant’s account of timing will be important. The record must be able to show dates for trauma, symptom onset, symptom persistence, and diagnosis.

Second factor’s constrained operation: The second factor , inability to obtain appropriate clinical management before clinical worsening , is not a standalone causation factor in all circumstances. Section 10(2) restricts its applicability: subsection 9(2) "applies only to material contribution to, or aggravation of, cervical dystonia where the person's cervical dystonia was suffered or contracted before or during (but did not arise out of) the person's relevant service" (s 10(2)). That is a conditional application that limits the second factor to particular pre‑existing or concurrent conditions and excludes cases where the condition arose out of relevant service. The wording is complex and liable to misapplication; practitioners should be precise when establishing the timing of the condition relative to relevant service and whether the claim is an aggravation or a new condition.

Evidence of inability to obtain appropriate clinical management: The instrument does not define "appropriate clinical management" or the standard by which access is judged. Practitioners must therefore assemble documentary evidence showing attempts to obtain management, reasons for inability (for example, lack of local services, administrative denial, or other barriers), and linkage to clinical worsening. The lack of a statutory definition increases the evidentiary burden on claimants to show the nature and reasonableness of attempts to obtain care.

Cross-referencing other Statements may change applicable factors: Section 11 mandates that if a factor refers to an injury or disease covered by another Statement, the factors in that other Statement apply as in force from time to time (s 11). This means that what a claimant must establish may change over time if the other Statement is amended. Practitioners should verify the current text of any cross‑referenced Statements that are relevant to the factors relied upon.

ICD‑10‑AM code is not determinative: The instrument makes clear that although ICD‑10‑AM code G24.3 is associated with cervical dystonia, the statutory meaning is the definition in subsection 7(2) (s 7(3)). Relying solely on an ICD code in clinical notes without demonstrating the condition fits the statutory definition (including exclusions) risks misapplication.

Death from condition requires contribution to terminal event: For death claims, the Statement treats death as attributable where the condition "contributed to" a terminal event or terminal condition (s 7(6)). The Schedule gives examples of terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). Practitioners must therefore show a causal contribution by the dystonia to one of those terminal events, which will require medical evidence bridging the dystonia to the terminal pathology.

Repeal of prior Statement and potential differences: The earlier Statement No. 63 of 2016 is repealed (s 4). Practitioners cannot assume continuity of criteria; they must compare the texts to determine whether the factual thresholds have changed. The instrument itself does not set out transitional provisions or address decisions made under the repealed Statement, so administrative practice may be important to resolve edge cases.

No penalties, but adverse administrative outcomes possible: There are no sanctions in the instrument, but failure to meet the listed factors is likely to result in an adverse claims decision under the VEA/MRCA processes. Practitioners should therefore treat the instrument as a hard evidentiary threshold for raising a reasonable hypothesis in the administrative adjudication context.

Potential interpretive disputes on phrases: Phrases such as "material contribution", "aggravation", "arise out of", "appropriate clinical management", and "clinical worsening" are not defined in the instrument and may be subject to interpretive dispute in decision-making or later review. Practitioners should gather evidence that addresses those concepts directly rather than assuming shared understanding.

Checklist for claimants and advisers

1. Confirm the claim falls within the scope of the Statement: verify that the claim is made under the provisions to which the Statement applies, namely section 120A of the VEA or section 338 of the MRCA (s 5). Ensure the claimant’s service is a form of "relevant service" as defined in Schedule 1 (operational; peacekeeping; hazardous; British nuclear test defence; warlike or non‑warlike service under MRCA).

2. Establish the condition matches the statutory meaning: obtain medical evidence that the dystonia is the chronic focal dystonia described in s 7(2)(a) and that it does not fall within any of the explicit exclusions in s 7(2)(b). If clinical notes rely on ICD coding, ensure the notes also address the statutory definition because s 7(3) makes the statutory definition determinative.

3. For the trauma factor (s 9(1)):

   • Produce contemporaneous medical records or other admissible evidence documenting the trauma to the neck, head, or shoulders.
   • Show dates for the trauma and for symptom onset. Demonstrate that local symptoms persisted for at least two weeks and that those symptoms occurred within one year before clinical onset.
   • Where available, provide ancillary evidence (police or accident reports, employer incident reports, eyewitness statements) to corroborate the trauma mechanism. The Statement lists examples of mechanisms (motor vehicle accidents, whiplash, assault, falls, heavy lifting) as non‑exhaustive guidance.

4. For the inability-to-obtain-management factor (s 9(2)):

   • Document efforts to obtain appropriate clinical management before clinical worsening (appointments sought, referrals, waiting lists, denial of services).
   • Provide evidence linking inability to obtain care to clinical worsening. Because s 10(2) limits the operation of s 9(2) to material contribution or aggravation where the condition was suffered or contracted before or during but did not arise out of relevant service, demonstrate timing of the original condition relative to relevant service.
   • Prepare medical expert opinion that ties the lack of timely/appropriate treatment to material contribution or aggravation of the dystonia.

5. For death claims:

   • Obtain the death certificate and clinical records documenting the proximate cause of death.
   • Obtain medical opinion linking the dystonia to the terminal event or condition listed in the Schedule (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function), demonstrating that the dystonia contributed to that terminal event (s 7(6); Schedule 1).

6. Address excluded causes: If there is any clinical suggestion that the dystonia is drug‑induced, generalised, paroxysmal, congenital, or due to a neurological disorder or structural lesion, collect diagnostic evidence to exclude those causes or, if they are present, consider whether other Statements of Principles apply.

7. Consider cross-referenced Statements: If a relied factor relates to another injury or disease covered by a separate Statement, identify and obtain that Statement and ensure relevant factors in that Statement are met (s 11). Verify the current text of that other Statement because s 11 requires application of the other Statement "as in force from time to time".

8. Prepare expert medical opinion: Given the factual and timing complexities, an appropriately qualified medical expert should set out:

   • Diagnosis in the statutory terms;
   • Date and nature of clinical onset;
   • Timing and duration of local symptoms following trauma, if relied upon;
   • The causal link or material contribution/aggravation analysis, especially where the second factor is relied upon; and
   • For death claims, an opinion bridging the dystonia to the terminal event.

Checklist for decision-makers and administrators

1. Apply the Statement for relevant claims: When assessing claims under VEA s 120A or MRCA s 338, use this Statement as the operative determinative list of medical concepts and factors (s 5). Ensure internal claim-adjudication guidance is updated to reflect the commencement date (19 May 2025) and the repeal of the prior Statement (s 2, s 4).

2. Verify statutory definitions before accepting ICD codes: Treat ICD‑10‑AM codes as adjuncts but apply the statutory definition in s 7(2) as decisive for whether the condition is the cervical dystonia covered by the Statement (s 7(3)-(4)).

3. Test the listed factors and their relation to relevant service: Require evidence that at least one of the s 9 factors exists and that the factor is related to the person’s relevant service (s 9, s 10(1)). For s 9(2), apply s 10(2) strictly: confirm that the condition was suffered or contracted before or during relevant service and that it did not arise out of relevant service, if material contribution or aggravation is to be found.

4. Clarify ambiguous factual terms through medical opinion: Where "clinical onset", "clinical worsening", "appropriate clinical management" or "material contribution" are in dispute, seek specialist medical opinion to interpret those concepts in the context of the individual’s health records.

5. Cross-reference other Statements where relevant: If any relied factor refers to another injury or disease that is the subject of a separate Statement, apply that other Statement as currently in force and require evidence that the other Statement’s factors are satisfied (s 11).

6. Document reasoning: Given the definitional exclusions and the potentially narrow temporal windows, record how the available evidence meets (or fails to meet) each element of the applicable factor and the relation to relevant service.

7. Note absence of penalties but administrative consequences: While the Statement contains no punitive measures, recognise that failure to establish the prescribed factors will normally result in an adverse decision. Ensure that claimants are given appropriate procedural rights in accordance with the VEA and MRCA processes for review and reconsideration.

Practical evidence-gathering tips

• Seek contemporaneous records: medical notes, incident reports, workplace injury files, imaging, specialist letters, hospital records and any records documenting attempts to access care.
• Obtain dated specialist reports that address the statutory definition and exclusions explicitly.
• For oral histories or late‑presenting records, obtain corroboration where possible.
• For death claims, ensure clinical causation opinions directly address contribution to a terminal event named in the Schedule.

Administrative housekeeping

• After 19 May 2025, do not use the repealed 2016 Statement for new claims (s 2-4).
• Check and track any other Statements that might be cross‑referenced and confirm their current texts before concluding that a factor referring to them is satisfied (s 11).
• Ensure case files make explicit which factor in s 9 is relied upon and document the link to relevant service as defined in the Schedule.

By aligning documentary evidence, expert opinion and the statutory wording of this Statement, claimants and decision-makers can address the specific thresholds the Repatriation Medical Authority has prescribed for raising a reasonable hypothesis connecting cervical dystonia or death from it to relevant service.