Statement of Principles concerning Charcot-Marie-Tooth disease (Balance of Probabilities) (No. 89 of 2023)

The instrument rests on a small set of interlocking legal and clinical concepts. The controlling clinical concept is the instrument's definition of Charcot‑Marie‑Tooth disease: a group of genetic disorders of myelin structure or axon function resulting in chronic peripheral motor and sensory neuropathies, with illustrative clinical features (progressive distal muscle weakness and atrophy, gait disturbance, absent stretch reflexes) (s7(2)). Although the ICD‑10‑AM code G60.0 is referenced, the instrument instructs decision‑makers to apply the statutory meaning in s7(2) rather than relying solely on the code (s7(3)-(4)).

A central legal concept is the causation standard. The Authority states its view is based on "sound medical‑scientific evidence" and that it is "more probable than not" that the disease and death from it can be related to relevant service (s8). The instrument’s title also signals the balance of probabilities standard. That standard operates in practice by requiring at least one of the specified factors in s9 to be established for a positive connection.

The factors themselves are narrowly expressed. There is a single listed factor that will, if present and related to service, suffice to establish connection: inability to obtain appropriate clinical management for Charcot‑Marie‑Tooth disease before the clinical worsening of the disease (s9(1)). The text ties that factor to material contribution to, or aggravation of, the disease only where the disease existed prior to or during relevant service but did not arise out of service (s10(2)). The instrument therefore distinguishes between disease arising out of service and disease pre‑existing or contracted before/during service which is then materially contributed to or aggravated by service.

The legal concept of "relevant service" is defined in the Schedule and excludes certain service categories. Relevant service means 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 instrument also defines "terminal event" for death cases, listing proximate or ultimate causes such as pneumonia, respiratory failure, cardiac or circulatory failure, and cessation of brain function (Schedule 1). Finally, s11 imports factors from other Statements of Principles where a s9 factor refers to another disease that has its own Statement of Principles, creating an inter‑instrument dependency.

This Statement affects three discrete groups as determined by its text. First, claimants who lodge requests that fall under s120B of the Veterans' Entitlements Act 1986 or s339 of the Military Rehabilitation and Compensation Act 2004 are directly affected because the Statement is declared to apply to such claims (s5). The statute thus shapes how entitlement decision‑makers will assess causation for those persons’ claims relating to Charcot‑Marie‑Tooth disease or death from it.

Second, the decision‑makers and medical assessors who apply the Statements of Principles are affected. The Repatriation Medical Authority itself is the instrument‑maker (s3). The instrument, by specifying the causation factors and evidential posture, constrains how medical causation is to be formulated when those decision‑makers consider whether the disease is connected with relevant service. The instrument makes explicit that the Authority’s view is that the relationship is more probable than not on the available sound medical‑scientific evidence (s8), which informs the standard applied by assessors.

Third, the instrument affects other Statement of Principles instruments and the administrative process for cross‑referencing conditions. Section 11 states that if a s9 factor refers to an injury or disease covered by another Statement, the factors in that other Statement apply according to its terms. Therefore, any persons or adjudicators dealing with overlapping conditions must consult additional Statements where referenced by s9 and apply those instruments as in force from time to time.

Notably absent from the instrument are explicit references to other actors such as hospitals, private insurers or third party administrators. The Statement’s application is limited to the statutory claim pathways enumerated in s5. The only statutory authorities named in the instrument text are the Repatriation Medical Authority, the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA), with "relevant service" categories set out in the Schedule. Consequently, the practical reach of the instrument is to people who are veterans or members of the Forces whose claims trigger VEA s120B or MRCA s339, and the administrative and medical personnel who process those claims.

The instrument creates no freestanding statutory duties or rights beyond defining what must be established for a causation finding within its scope. It does, however, impose a de facto duty on claimants seeking connection under the named statutory claim provisions: a claimant must establish, on the balance of probabilities, at least one of the factors listed in section 9 for Charcot‑Marie‑Tooth disease or death from it to be regarded as connected with relevant service (s9). Practically, that creates the evidentiary burden of adducing proof that one of the enumerated factors existed and that it was related to the relevant service rendered (s10(1)).

For decision‑makers, the instrument imposes a duty to apply the medical‑causation framework as set out by the Repatriation Medical Authority. The Authority expresses a view based on sound medical‑scientific evidence that the disease and death from it can be related to relevant service on the balance of probabilities (s8). Decision‑makers applying the Statement must therefore assess causation in light of that standard and the specific factors in s9, and where a s9 factor refers to another condition that has its own Statement, they must apply the terms of that other Statement (s11).

The instrument also clarifies when the single s9(1) factor is available: it applies only to material contribution to, or aggravation of, Charcot‑Marie‑Tooth disease where the disease was suffered or contracted before or during, but did not arise out of, the person’s relevant service (s10(2)). That restricts the claimant’s ability to rely on s9(1) in circumstances where the disease is alleged to have arisen out of service, or to have been first contracted after service.

Regarding the right to have a claim assessed, the instrument does not confer new entitlements. Instead it defines the medical criteria that will be used to determine whether existing claim pathways under VEA s120B or MRCA s339 are met (s5). It also includes a treatment of death from Charcot‑Marie‑Tooth disease: for the instrument’s purposes, death may be included where it resulted from a terminal event or condition contributed to by the disease, with terminal events listed in the Schedule (s7(5); Schedule 1).

The instrument does not establish administrative procedural rights such as review or appeal pathways, nor does it prescribe obligations for non‑statutory actors such as private clinicians to report. Any procedural duties or rights remain those established by the underlying Acts and their administrative regimes; the Statement’s role is to provide the medical causation template to be applied within those regimes.

The Statement of Principles is a declaratory instrument setting medical‑causation parameters for statutory claims. It contains no provisions that create criminal offences, civil penalties, administrative fines, or enforcement mechanisms within its text. The instrument does not prescribe enforcement actions nor attach sanctions for non‑compliance with any of its provisions.

Enforcement, in the operational sense, occurs through decision‑makers responsible for adjudicating claims under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. The instrument expressly applies to claims to which VEA s120B or MRCA s339 apply (s5), which means that any legal consequence is a consequence of the adjudicative machinery of those statutes using this Statement as the causation benchmark. The Repatriation Medical Authority is the issuing body (s3) and it frames the medical evidence basis (s8); however, the instrument itself does not give the Authority powers to impose penalties.

Because no enforcement provisions appear in the instrument, compliance is principally a matter of aligning evidence to the causation factors when making or deciding claims. If a decision‑maker were to ignore the Statement in adjudicating a claim within its scope, any remedy, review or challenge would have to be pursued under the procedural or judicial review mechanisms available under the VEA or MRCA or general administrative law, none of which are set out in this instrument. The Statement contains no internal procedural rules for contesting a medical view, no notice or reporting obligations, and no time limits.

In short, the instrument functions as an evidentiary template rather than an enforcement statute. Its practical effect is channelled through the decision‑making apparatus authorised by the parent Acts; the Statement determines how causation ought to be judged where relevant, but it does not itself create enforcement powers, penalties or sanctioning mechanisms.

The Statement is expressly made under subsection 196B(3) of the Veterans' Entitlements Act 1986 (s3). Its application is limited to claims to which s120B of the VEA or s339 of the Military Rehabilitation and Compensation Act 2004 apply (s5). Consequently, its legal effect is subordinate to those Acts and it operates only within the claim streams established by them. The instrument also repeals a prior Statement No. 22 of 2015 (s4); that repeal means the 2023 Statement supplants the prior instrument for the purposes indicated.

The instrument interacts with classification standards by reference to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD‑10‑AM). It notes that Charcot‑Marie‑Tooth disease attracts ICD‑10‑AM code G60.0, but it instructs decision‑makers to apply the statutory definition in s7(2) for the purposes of the Statement (s7(3)-(4)). This creates an interface between clinical classification codes used in healthcare settings and the statutory wording that will be applied in claims settings.

Section 11 creates a concrete cross‑instrument interaction. If a s9 factor refers to another injury or disease that itself has a Statement of Principles made under subsection 196B(3) of the VEA, then the factors in that other Statement apply in accordance with its terms as in force from time to time. This provision mandates coordinated application of multiple Statements where one condition or factor intersects with another Statement. The effect is to require decision‑makers to consult and apply other Statements where relevant, rather than to treat this Statement in isolation.

The Schedule defines "relevant service" with specific inclusions and exclusions: eligible war service (other than operational service) and defence service (other than hazardous service and British nuclear test defence service) under the VEA, and peacetime service under the MRCA (Schedule 1). That definition will determine which claimants fall within the jurisdictional scope created by the parent statutes. The Schedule also defines "terminal event" for death cases, listing specific proximate or ultimate causes that qualify (Schedule 1). These definitional elements therefore interact with statutory thresholds in the VEA and MRCA to shape whether this Statement applies to any given case.

The Statement does not amend or purport to displace other substantive provisions of the VEA or MRCA. Its role is to provide the Repatriation Medical Authority’s view on medical causation within the statutory framework of those Acts. Any procedural, review or remedial mechanisms required to challenge a decision that relies on this Statement must be sought under the procedures of the parent Acts or general administrative law, which are not set out in this instrument.

This instrument is identified as Statement of Principles No. 89 of 2023 and is dated 25 August 2023 with commencement on 26 September 2023 (s1, s2). The instrument explicitly repeals the prior Statement of Principles concerning Charcot‑Marie‑Tooth disease No. 22 of 2015, which the instrument cites by its Federal Register of Legislation identifier F2014 L01829 (s4). The repeal means that, from the commencement date, the 2015 Statement is no longer in force and its factors and statements are superseded by the present instrument.

Beyond the express repeal of the 2015 instrument, the text contains no other amendment entries. It does not itself amend the Veterans' Entitlements Act 1986 or the Military Rehabilitation and Compensation Act 2004. The Statement is made pursuant to the authority granted in subsection 196B(3) of the VEA (s3); any historic amendments to that enabling provision or to the parent Acts are not recorded in this instrument.

The Schedule also contains definitional notes which reflect drafting choices rather than a history of change. For example, the instrument reiterates that references to ICD‑10‑AM codes are to the Tenth Edition, effective date 1 July 2017, with ISBN given (s7(4) note). That cross‑reference to a specific edition of the classification system is a snapshot in time and may affect interpretive consistency if later editions are used in clinical contexts.

There are no transitional provisions included in the instrument directing how claims in progress at the date of commencement are to be handled. The instrument states that it "applies to a claim to which section 120B of the VEA or section 339 of the MRCA applies" (s5), but it does not spell out whether pending matters started under the 2015 Statement are to be determined under the old or new instrument. The absence of an express transitional rule means that administrative practice will determine how the repeal is operationalised for claims initiated before commencement, subject to any directions elsewhere in the administrative regime not included in this instrument.

No subsequent amendments or revocations after the 2023 date are recorded in the text provided. The instrument’s own clause 11 contemplates that other Statements of Principles may be in force "from time to time", indicating that cross‑instrument applicability is dynamic and that the present instrument may interact with future or amended Statements.

The instrument as presented contains no litigation history. It names no cases, does not summarise any judicial or administrative decisions, and does not record any legal challenges to prior versions of the Statement or to its content. The only historical element contained is the repeal of a prior Statement No. 22 of 2015 (s4). No judicial treatment of either the prior or current Statement is contained within the instrument.

Because no litigation materials or case law are cited, the instrument does not disclose how tribunals or courts have interpreted comparable Statements of Principles, the defined causation factor in s9, the meaning of terms such as "appropriate clinical management" or "clinical worsening", or the procedural interplay between Statements and decisions under the VEA and MRCA. The instrument also does not specify how decision‑makers should resolve evidentiary disputes, nor does it provide guidance as to what documentary or expert material will be decisive in contested matters.

The absence of litigation references in the instrument means that any practitioner seeking to understand how the instrument will be treated by courts or review bodies will need to look beyond this text to the broader body of administrative and veterans law and to any case history not contained here. From the instrument alone it is not possible to infer precedent, appellate patterns, or the degree of deference accorded to the Repatriation Medical Authority’s statements by courts. The only authoritative source within the instrument as to the Authority’s view is the statement in s8 that its conclusion is based on the "sound medical‑scientific evidence available" and adopts the more probable than not standard.

For administrative or evidentiary strategies, the instrument provides the framework that must be applied, but it contains no illustration of adjudicative practice, no litigated determinations, and no record of appeals or challenges to this particular Statement. Any litigation history relevant to interpreting or challenging the present Statement will lie outside the instrument and would need to be compiled from external judicial records and administrative tribunal decisions, which are not part of the material provided here.

Several concrete interpretive and procedural traps are embedded in the instrument’s limited text. First, the instrument lists only one causal factor in s9(1): inability to obtain appropriate clinical management before the clinical worsening of Charcot‑Marie‑Tooth disease. That narrow enumeration means that claimants whose causal case does not squarely fit that phrase may find that the Statement offers no direct pathway to a positive causation finding. The instrument therefore narrows the universe of qualifying factual scenarios for which the Authority's view will be applied.

Second, multiple terms in the sole listed factor are open to administrative and medical interpretation: "inability to obtain", "appropriate clinical management", and "clinical worsening". The instrument provides no operational definitions for these phrases. Decision‑makers will therefore need to make fact‑sensitive judgments about what constitutes appropriate management, whether the management was in fact unavailable, and whether the temporal threshold of "before the clinical worsening" is met (s9(1)). Those interpretive judgments create uncertainty and potential variability of outcome across cases.

Third, the instrument restricts the availability of the s9(1) factor to circumstances where the person’s Charcot‑Marie‑Tooth disease "was suffered or contracted before or during (but did not arise out of) the person's relevant service" (s10(2)). This drafting choice excludes reliance on s9(1) where the disease is alleged to have arisen out of service. Claimants who allege the disease first manifested as a consequence of service will not be able to meet causation under the listed factor. That is a precise jurisdictional limitation that may catch claimants who believe their disease is service‑originating.

Fourth, the instrument’s definition of "relevant service" (Schedule 1) excludes certain service categories, including operational service and hazardous service and British nuclear test defence service under the VEA. Claimants whose service falls outside the Schedule’s categories will find the Statement does not apply. The narrow definitional scope requires careful factual mapping of the claimant’s service record to the Schedule’s categories.

Fifth, section 11 cross‑references other Statements of Principles if a factor refers to another injury or disease. That creates a dependency risk: a s9 factor that incorporates another disease will require a decision‑maker to consult that other Statement as in force. Practitioners must therefore track multiple Statements and their current versions to understand the full causation picture.

Sixth, the Statement references ICD‑10‑AM code G60.0 but disclaims that the statutory meaning is the one in s7(2) (s7(3)-(4)). This may create a disconnect between clinical coding used in hospital records and the statutory description, potentially complicating evidentiary matching if a clinician’s notes rely strictly on code nomenclature rather than the statutory language.

Finally, the instrument contains no transitional rules addressing claims in progress at commencement. It is silent about how existing matters commenced under the prior 2015 Statement will be treated following repeal (s4). Administratively, this gap can create uncertainty in the short term for claimants and officers processing matters proximate to the commencement date.

All these points are literal consequences of the instrument’s wording. The interpretive gaps and narrow factor list are features of the instrument rather than of external practice; they will be realised in adjudication unless filled by administrative guidance or practice directions not contained in this text.

For claimants and their advisers: the instrument sets a focused evidentiary task. To rely on the Statement in a claim under VEA s120B or MRCA s339 (s5), a claimant must establish at least one of the factors in s9, and that the factor was related to the person’s relevant service (s10(1)). The sole listed factor requires evidence that there was an inability to obtain appropriate clinical management for Charcot‑Marie‑Tooth disease before the clinical worsening of the disease (s9(1)). Where the claimant seeks to establish material contribution to or aggravation of a pre‑existing or pre‑contracted disease under s9(1), they must show the disease was suffered or contracted before or during relevant service and did not arise out of that service (s10(2)).

Practical compliance steps, grounded in the instrument, are these. First, assemble contemporaneous and retrospective medical records that show the diagnosis of Charcot‑Marie‑Tooth disease in language matching the statutory definition (s7(2)). Although ICD‑10‑AM code G60.0 is noted, the Statement instructs application of the statutory definition, so records that explicitly describe peripheral motor and sensory neuropathies and the characteristic clinical features will align most closely with the instrument (s7(2)-(4)).

Second, document the timeline: evidence that the disease was present before or during service, or else that it did not arise out of service if relying on s9(1) material contribution/aggravation (s10(2)). Service records that precisely identify the nature of service will be necessary to map the claimant’s service to the Schedule’s definition of relevant service (Schedule 1).

Third, collect evidence that the claimant was unable to obtain appropriate clinical management prior to the clinical worsening of the disease. This requires records or statements demonstrating attempts to access care, reasons care was not provided or available, any administrative or geographic impediments, and the temporal sequence showing that the failure to access care preceded clinical worsening (s9(1)). The Statement itself does not specify what counts as "appropriate clinical management", so practitioners should seek clinical opinions that define appropriate treatment in the claimant’s circumstances and link absence of that treatment to subsequent worsening.

Fourth, where the s9(1) factor refers to another disease covered by its own Statement, identify and gather the factors and evidence required by that other Statement, because s11 requires application of that Statement’s factors as in force from time to time (s11). This may necessitate cross‑consultation with other Statements and relevant clinical documentation.

For decision‑makers and medical assessors: apply the Authority’s view that the relationship is more probable than not on the sound medical‑scientific evidence available (s8). In practice, that means assessing whether the evidence establishes at least one s9 factor and whether that factor is causally related to relevant service as required by s10(1). Where the claimant relies on s9(1), verify the temporal sequencing and the presence of disease prior to or during service, and ensure the disease did not "arise out of" service (s10(2)).

Administrative practitioners should note the lack of operational definitions for key terms in the Statement and therefore frame requests for medical opinions to elicit explicit views on what constitutes "appropriate clinical management", whether the claimant was in fact unable to obtain such management and causal opinion linking the lack of management to subsequent clinical worsening. Where death is claimed, ensure the death is characterised as a terminal event or condition that was contributed to by the disease, using the Schedule’s terminal event list where relevant (s7(5); Schedule 1).

Finally, track the currency of other Statements of Principles that may be referenced under s11, because the instrument mandates applying those other Statements as in force "from time to time" (s11). Administrative compliance therefore requires ongoing monitoring of Statements and ensuring the correct versions are used in any determination.