Statement of Principles concerning chronic exertional compartment syndrome of the lower leg (Reasonable Hypothesis) (No. 98 of 2023)

The single core medical concept addressed is chronic exertional compartment syndrome of the lower leg. The Statement provides a working case definition in s7(2): for these purposes the condition means raised muscle compartment pressure that manifests with exercise-induced pain and tightness originating in the calf or shin and which typically resolves or reduces with rest. The definition explicitly excludes a set of alternative diagnoses and pathologies (s7(2)(a)(i)-(vi)): fracture (including stress fracture), lower leg tendinopathies or bursitis, certain nerve entrapments (sural or superficial peroneal), popliteal artery entrapment syndrome, acute sprain and strain, and vascular insufficiency. Those exclusions are part of the instrument’s delimitation of the clinical entity that can be linked to service under this Statement.

Death from the condition is included where the chronic exertional compartment syndrome materially contributed to a terminal event or condition that was a proximate or ultimate cause of death (s7(3); Schedule 1, terminal event). Terminal events are drawn broadly and include pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (Schedule 1).

The threshold legal concept used throughout is the “reasonable hypothesis” test implicit in the instrument’s title and made concrete in s9. Section 9 states that at least one of a set of enumerated factors must exist “as a minimum” before it can be said that a reasonable hypothesis has been raised connecting the condition or death to relevant service. Those factors are measurable and time‑bounded. They are:

• Running or jogging an average of at least 30 kilometres per week for the four weeks before clinical onset or worsening (s9(1));
• Undertaking weight-bearing exercise involving repeated activity of the affected lower leg at a minimum intensity of 5 METs, for at least four hours per week, for the four weeks before onset or worsening (s9(2), with Note 1 examples);
• A sudden increase in frequency, duration or intensity of weight-bearing activity on the affected lower leg by at least 100 percent, to a minimum intensity of 5 METs, for at least two hours per day, within the one week before onset or worsening (s9(3));
• Inability to obtain appropriate clinical management for the condition before clinical worsening (s9(4)).

MET is defined in Schedule 1 as a unit of measurement of the level of physical exertion, with precise physiological conversions (1 MET = 3.5 ml O2/kg/min, or 1.0 kcal/kg/hour, or resting metabolic rate). Note 1 to s9 gives examples of activities at 5 METs, including marching, sustained brisk walking, playing football, and dancing. These definitions and numeric thresholds translate clinical and activity histories into discrete evidentiary predicates for the reasonable hypothesis test.

The instrument contains two important relational rules. First, the factors relied on must be related to the person’s relevant service as defined in Schedule 1 (s10(1) and Schedule 1 relevant service entries a-f). Second, the “clinical worsening” aspects of the factors are confined to cases where the condition was suffered or contracted before or during (but did not arise out of) relevant service; in that subset of cases the worsening must materially contribute to or aggravate the condition (s10(2)). Lastly, s11 governs overlap with other Statements of Principles: where a factor in s9 refers to an injury or disease already covered by another Statement of Principles, the terms of that other Statement apply.

Taken together, the instrument translates clinical features and activity histories into a set of minimum, evidence‑oriented conditions that, if met and related to relevant service, will satisfy the threshold that “a reasonable hypothesis has been raised” for the purposes of the specified VEA and MRCA claim provisions.

Primary statutory subjects of the instrument are persons making claims to which section 120A of the Veterans’ Entitlements Act 1986 or section 338 of the Military Rehabilitation and Compensation Act 2004 applies (s5). The Schedule 1 definition of relevant service identifies the types of service that can supply the required link to the factors: operational service, peacekeeping service and hazardous service under the VEA; British nuclear test defence service under the VEA; and warlike and non‑warlike service under the MRCA (Schedule 1, relevant service). The instrument therefore targets veterans and former members of the Forces whose service falls within those statutory categories.

The Repatriation Medical Authority is the decision instrument maker: it made the Statement under s196B(2) of the VEA and recorded the RMA’s position that sound medical‑scientific evidence indicates the condition and death from it can be related to relevant service (s3, s8). The instrument will be used by the decision makers who assess claims under the VEA and the MRCA, since it applies to claims governed by the specified sections (s5). The instrument itself does not specify which administrative actor decides claims, but it is a component within the statutory regime that governs adjudication under the cited provisions.

Clinicians and medical practitioners who provide opinions in support of claims are indirectly affected because the instrument sets out the clinical and activity predicates that will be necessary for a reasonable hypothesis. Medical records, diagnostic reports (for example, evidence of raised compartment pressures) and records showing exercise patterns or treatment access will be the evidentiary inputs needed to align a clinical history with the factors in s9. Similarly, service employers, unit clerks and training records custodians may be queried to provide contemporaneous evidence of service training, marching, field exercises, or other activities that meet the MET and intensity specifications.

Legal advisers, claims preparers and advocates who represent claimants are affected in that the instrument specifies the minimum factual matrix that must be shown to raise a reasonable hypothesis. The instrument places numerical and temporal precision on what counts: distances (30 km/week), hours (4 hours per week, 2 hours per day), intensities (5 METs) and limited pre‑onset windows (four weeks or one week depending on the factor). Those thresholds determine which persons’ activity histories will meet the Rule and which will not.

The instrument does not itself create or change monetary entitlements, does not create compliance obligations for non‑claimant civilians, and does not prescribe penalties. Its effect is to change the medical-evidentiary standard applied in the claims framework, thereby affecting the evidential burden and documentation required for successful linkage of the condition to relevant service.

The Statement of Principles imposes no criminal or administrative penalties and does not itself prescribe affirmative duties on private citizens. Instead the instrument sets out the required evidentiary factors that must be present, at minimum, to establish the factual basis for a “reasonable hypothesis” that a person’s chronic exertional compartment syndrome of the lower leg or death from that condition is related to their relevant service (s9). In that respect the instrument generates indirect duties in practice: claimants, their medical advisers and representatives must assemble and present evidence that corresponds to the factors and thresholds in s9 and the definitions in Schedule 1.

Rights implied by the instrument are procedural and evidential within the claim process established under the VEA and the MRCA. Explicitly, the instrument applies to a claim to which s120A of the VEA or s338 of the MRCA applies (s5). Those statutory claim provisions, outside the instrument, set out rights and procedures for review and entitlements. What this instrument does is define a medical-evidentiary right for claimants: if the minimum factors in s9 exist and are related to relevant service (s10(1)), then the threshold of raising a reasonable hypothesis is met. The instrument thus shapes the standard of proof or threshold to be applied by adjudicators when determining whether further consideration of a service connection is warranted.

Decision‑making duties flow to administrators and medical assessors applying the VEA and MRCA provisions. They are obliged to use the Statement of Principles where a claim falls within s120A or s338, because the instrument is made under s196B(2) of the VEA (s3, s5). Section 11 clarifies an administrative duty when factors in s9 overlap with another Statement of Principles: the other Statement applies in accordance with its terms as in force from time to time. That creates an administrative obligation to check for, and apply, any relevant alternate Statement of Principles when a factor in s9 refers to an injury or disease already covered elsewhere (s11).

The instrument also creates rights to rely on specific clinical definitions and exclusions. For example, a practitioner may assert that the person’s diagnosis falls outside the excluded conditions listed in s7(2)(a)(i)-(vi). Conversely, an adjudicator has a right to exclude claims where the clinical picture aligns with one of the excluded conditions, because the instrument itself excludes those pathologies from the scope of chronic exertional compartment syndrome of the lower leg for these purposes (s7(2)).

The “clinical worsening” rule in s10(2) establishes a rights/duties boundary specific to persons whose condition predates service. It limits the class of cases in which clinical worsening can be invoked as material contribution or aggravation: that factual legal characterisation only applies where the condition was suffered or contracted before or during service but did not arise out of it. Practitioners and claimants therefore have a right to rely on clinical worsening only within that defined class, and decision-makers have a duty to confine use of the clinical worsening factors to that class.

Finally, the instrument imposes evidentiary requirements that translate into practical duties: to quantify distances, times and intensities in a way that corresponds to the thresholds in s9 and Schedule 1, and to document treatment access and timing where s9(4) is relied upon. Those duties are not enumerated as compliance obligations in the instrument but follow from its role as a specification of the minimum facts needed to raise the reasonable hypothesis threshold.

The text of the Statement of Principles contains no penalty provisions, enforcement mechanisms, monetary fines, or criminal sanctions. It is an evidentiary instrument made under s196B(2) of the Veterans’ Entitlements Act 1986 that specifies the factual and medical linkages required to raise a reasonable hypothesis that chronic exertional compartment syndrome of the lower leg, or death from it, is related to relevant service (s3, s9). Enforcement of the Statement’s content therefore occurs indirectly through its application in the statutory claims processes governed by the VEA and the MRCA.

Because the instrument applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (s5), adjudicators, medical assessors and administrators who operate under those Acts will implement the instrument’s requirements when assessing whether a claim condition is linked to relevant service. The instrument itself does not describe the adjudicative steps, remedies, review routes, or sanctioning powers available under the VEA or MRCA; those matters remain within the scope of the parent Acts and their administrative frameworks. The Statement binds decision-making in the sense that it prescribes the facts that must underpin a reasonable hypothesis, but the procedure for enforcing entitlement decisions, and any penalties for false claims or negligence, are not within the language of this instrument.

Two practical enforcement implications follow from the Statement’s structure. First, failure by a claimant to produce evidence meeting one of the s9 factors will mean, as a factual result, that the reasonable hypothesis threshold has not been met based on this Statement. That factual outcome will be applied by adjudicators under the VEA/MRCA framework, which may lead to denial of the service-connection element of a claim. Second, where evidence exists but is contested, the instrument’s precise numerical and temporal thresholds (for example, 30 kilometres per week, four weeks, 5 METs, two hours per day) provide clear lines along which adjudicators may accept or reject the sufficiency of evidence. The instrument therefore creates a specific evidentiary enforcement regime for claim assessment, but not direct statutory penalties contained within the instrument itself.

For the record, the instrument repeals the earlier Statement of Principles concerning shin splints No. 9 of 2015 (s4). That repeal may have downstream effects in administrative practice where prior claims were assessed under the older Statement, but the mechanics and consequences of such transitional enforcement are not described in the instrument.

This Statement of Principles is made under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (s3), and it expressly applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (s5). The instrument therefore operates as a subordinate, evidentiary instrument within the statutory architecture of the VEA and the MRCA. It does not purport to amend those parent Acts. Its functional role is to provide the medical‑evidentiary framework that adjudicators must use when applying the relevant service link provisions in those Acts.

Schedule 1 defines MRCA as the Military Rehabilitation and Compensation Act 2004 and VEA as the Veterans’ Entitlements Act 1986. The Schedule also specifies the range of “relevant service” categories that may supply the service link required by s10(1): operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike and non‑warlike service under the MRCA. That cross-definition makes clear which service types are legally relevant in claims where the Statement is applied.

Section 11 provides a direct interaction rule with other Statements of Principles: where a factor in s9 refers to an injury or disease for which another Statement of Principles has been determined under subsection 196B(2) of the VEA, the factors in that other Statement apply in accordance with its terms as in force from time to time. Practically, this means that when the s9 factor overlaps medically with another injury or disease already governed by a different Statement of Principles, adjudicators must apply that other Statement’s terms rather than treating the overlapping element as governed only by s9. This creates a hierarchy and cross-application protocol among Statements of Principles made under the same subsection 196B(2) power.

The instrument repeals the Statement of Principles concerning shin splints No. 9 of 2015 (s4). That repeal alters the corpus of Statements of Principles available to adjudicators and claimants. If an issue previously assessed under the Shin Splints Statement now meets the chronic exertional compartment syndrome definition and factors, it will be assessed under this instrument. Conversely, if a case continues to align with the conditions governed by an existing other Statement, the cross-application rule in s11 will direct adjudicators to that relevant Statement.

The instrument does not set out procedures for appeals, review, procedural fairness or other administrative law processes, nor does it describe how its findings interact with other non‑VEA/MRCA statutes. Those matters remain governed by the procedural, merits, and judicial review frameworks applicable to decisions under the VEA and the MRCA. The Statement therefore functions as a technically specific evidentiary adjunct to those statutes rather than as an independent source of adjudicative law. Decision-makers must integrate this Statement with the operative provisions, rights and obligations in the VEA and MRCA during claim assessment.

The instrument identifies itself as the Statement of Principles concerning chronic exertional compartment syndrome of the lower leg (Reasonable Hypothesis) (No. 98 of 2023). It bears a date of 25 October 2023, and it commences operation on 28 November 2023 (s2). The Repatriation Medical Authority affixed the Common Seal to the instrument at the direction of the Chairperson, Professor Terence Campbell AM; that attestation appears on the instrument. The instrument expressly repeals an antecedent Statement: the Statement of Principles concerning shin splints No. 9 of 2015, Federal Register of Legislation No. F2014L01805, which was itself made under subsection 196B(2) of the VEA (s4). No other amendments, transitional savings clauses, or staged commencements are recorded within the text provided.

Because the instrument is a fresh Statement of Principles, its immediate textual amendment history is limited to: the date of determination (25 October 2023), the commencement date (28 November 2023), and the repeal of the prior shin splints Statement (s4). The Schedule 1 dictionary attached to the instrument contains the definitional items used throughout, and those definitions form the operative terms of the instrument from commencement.

The instrument makes a substantive definitional change relative to the repealed shin splints Statement by substituting a specific chronic exertional compartment syndrome construct with discrete activity‑based factors and intensity metrics (s7, s9; Notes and Schedule 1). Those changes are recorded in the repeal and replacement mechanic in s4. No transitional operative provisions appear in this document as published; the text does not specify whether claims lodged before commencement will continue to be assessed under the older Statement or will be transitioned to the new Statement. Practitioners must therefore check the administrative practice and any supplementary guidance from the department or the RMA regarding transitional arrangements when advising clients.

No later amendments or revisions to the Statement are recorded in the instrument itself. Subsequent amendments, if any, would appear in newer instruments or consolidated versions of Statements of Principles maintained by the Repatriation Medical Authority or by the administering agency. The instrument’s schedule reiterates that MRCA and VEA are defined terms and that “relevant service” covers the enumerated service categories, a point important for any future amendment that might adjust the scope of relevant service.

The text of this Statement of Principles contains no reference to any litigation, court decisions, or tribunal determinations that have interpreted or tested this instrument. It names no cases and records no judicial history. The instrument does, however, repeal the earlier Statement of Principles concerning shin splints No. 9 of 2015 (s4), but no litigation relating to that prior instrument is mentioned.

Because the Statement is an administrative medical instrument made under subsection 196B(2) of the VEA, litigation that might engage it would arise through judicial review or appeal of VEA or MRCA decisions that adopted or applied the Statement in particular claimant determinations. The instrument itself contains no summary of such decisions, nor does it cite precedent. Any case law interpreting the operation of this specific Statement or the interaction between Statements of Principles and the VEA/MRCA adjudicative framework is therefore not recorded in the instrument you supplied.

Practitioners should be aware that the instrument’s operational interaction with adjudicators and tribunals will be shaped by how tribunal members and courts treat the “reasonable hypothesis” threshold and the evidentiary weight of the s9 factors when assessing claims under s120A of the VEA or s338 of the MRCA. However, the instrument does not supply or summarise those judicial answers. If litigation history is required for strategy or precedent, users of this instrument will need to consult case law databases, tribunal decisions and administrative decisions external to the instrument to establish how courts and tribunals have applied equivalent Statements of Principles or these specific s9 factors in practice.

In short, the instrument contains no litigation history. It is a medical-evidentiary specification that will be engaged within the broader statutory and adjudicative machinery of the VEA and MRCA, and any litigation that interprets its terms will be found outside the text of this Statement.

This Statement of Principles contains a number of specific drafting features and discrete thresholds that commonly produce confusion in practice. The following are precise, source‑grounded items to watch for when advising claimants or preparing evidence.

1. The instrument is about chronic exertional compartment syndrome of the lower leg as defined in s7(2). The definition requires raised muscle compartment pressure with exercise‑induced pain and tightness originating in the calf or shin that typically resolves or reduces with rest. The instrument does not use colloquial labels; it excludes several distinct diagnoses explicitly (s7(2)(a)(i)-(vi)). If a claimant’s presentation fits one of the excluded categories, this Statement will not cover the condition. Practitioners must map the clinical diagnosis to the instrument’s narrow definition before relying on the s9 factors.

2. Numerical thresholds are strict and time‑limited. The factors in s9 include precise metrics: 30 kilometres per week averaged over four weeks for running or jogging (s9(1)); at least 5 METs intensity and four hours per week for four weeks for weight-bearing repeated activity (s9(2)); or an increase of at least 100 percent to a minimum of 5 METs for at least two hours per day within the one week before onset for the acute increase scenario (s9(3)). These are minimums that “must as a minimum exist” to raise the reasonable hypothesis (s9 introductory text). Evidence that falls short of these thresholds will not meet the instrument’s minimum requirement.

3. MET is precisely defined in Schedule 1 and may not be obvious in everyday descriptions of activity. 1 MET is given physiological conversions (1 MET = 3.5 ml O2/kg/min or 1.0 kcal/kg/hour or the resting metabolic rate). Note 1 to s9 supplies examples of activities around the 5 MET level, including marching and sustained brisk walking. Do not conflate casual or undifferentiated descriptions of exertion with the 5 MET benchmark; expert opinion or validated activity conversion tables will be necessary to tie a reported activity to the 5 MET threshold.

4. The instrument distinguishes between onset and clinical worsening and constrains the use of clinical worsening. Section 10(2) states that the clinical worsening aspects of the s9 factors apply only where the person’s condition was suffered or contracted before or during (but did not arise out of) relevant service, and only insofar as material contribution to, or aggravation of, the condition is at issue. This means that if the condition arose out of the service in the first place, the clinical worsening thresholds in s9 may not be the operative link. Practitioners must carefully classify whether the condition “arose out of” service or whether it pre‑existed and was aggravated by service, as the application of s9 differs accordingly.

5. The “inability to obtain appropriate clinical management” factor (s9(4)) is open textured. The instrument does not define what constitutes “appropriate clinical management” or how inability will be measured. This is a fact‑intensive threshold and likely to be contested. Documentary evidence of attempts to access care, why care was unavailable, and the clinical consequences of lack of management will be necessary to rely on this factor.

6. Interaction with other Statements of Principles can change which instrument governs. Section 11 requires the application of the other Statement of Principles if a s9 factor refers to an injury or disease already governed by another Statement determined under s196B(2) of the VEA. This creates an administrative check: identify any overlapping Statements and apply their terms “as in force from time to time.” Failure to identify an overlapping Statement can lead to mis‑application of factors.

7. Death is included, but via contribution to terminal events. Section 7(3) and the Schedule define death from the condition as death from a terminal event or condition that the condition contributed to. Terminal events listed are varied and include pneumonia and cardiac arrest. That means a causal pathway must be established from chronic exertional compartment syndrome to the terminal event, not merely the occurrence of the terminal event alone.

8. Repeal of the shin splints instrument. Section 4 repeals the earlier Shin Splints Statement No. 9 of 2015. Practitioners dealing with older claims must check whether past decisions relied on the prior instrument and whether administrative transition guidance exists because the instrument does not itself provide transitional rules.

9. The instrument is silent on evidentiary standards beyond the “reasonable hypothesis” threshold. It prescribes what facts, at minimum, are required to raise the hypothesis but does not describe how strongly those facts must be proved, or the relative weight of competing medical opinions. The statutory phrase “reasonable hypothesis” is converted into the discrete s9 factors, but real adjudication will still involve assessment of the quality and sufficiency of the documentary and expert evidence provided.

10. The instrument uses the phrase “must as a minimum exist” in s9. That wording indicates these are threshold, not exhaustive, factors. However, this does not mean other evidence cannot be relevant; it means that at least one of these specified factors must be present before a reasonable hypothesis will be said to exist. Practitioners should therefore ensure at least one factor is clearly established in evidence, while also providing supporting clinical and contextual material.

These items are not interpretive preferences. They are mechanical consequences of the instrument’s text and structure and should be checked against the underlying medical records, service records and contemporaneous logs when preparing or disputing claims.

Complying with this Statement of Principles for a claim under the VEA or the MRCA requires assembling evidence that ties the claimant’s clinical condition and activity history to at least one of the s9 factors and establishing that the relevant factor was connected to the person’s relevant service (s10(1)). The following source‑grounded checklist translates the Statement’s requirements into practical steps for claimants, clinicians and representatives to follow.

1. Confirm diagnosis against the instrument’s definition:

   • Obtain medical documentation that the person has chronic exertional compartment syndrome of the lower leg as defined in s7(2): evidence of raised muscle compartment pressure, exercise‑induced pain and tightness in the calf or shin that typically resolves or reduces with rest. Document the diagnostic method used (clinical, pressure measurement, etc.), the date of clinical onset, and any objective findings.
   • Ensure the presentation is not one of the excluded conditions listed in s7(2)(a)(i)-(vi). If an excluded condition is present, the Statement does not apply to that diagnosis.

2. Establish timing and the relevant onset/worsening window:

   • Identify the clinical onset date or the date of clinical worsening. The s9 factors reference precise pre‑onset windows: four weeks for factors s9(1) and s9(2), one week for the sudden increase scenario in s9(3). Ensure medical records contain a clear statement of when symptoms began or worsened.

3. Demonstrate at least one of the s9 factors with documentary and corroborative evidence:

   • For s9(1): Produce running/jogging logs, training schedules, GPS or wearable activity records, unit training rosters, or affidavits showing an average of at least 30 km per week over the four weeks before onset or worsening.
   • For s9(2): Document weight‑bearing exercise involving repeated activity of the affected lower leg at a minimum intensity of 5 METs, and showing at least four hours per week for the four weeks before onset or worsening. Use activity logs, training timetables, and clinician statements converting the activity to approximate METs using the Schedule 1 MET definition. Note 1 gives examples of 5 MET activities; where necessary, obtain an expert conversion.
   • For s9(3): Show an increase in frequency, duration or intensity by at least 100 percent to at least 5 METs for at least two hours per day within the one week before onset or worsening. Comparative documentation (before/after schedules, training orders showing intensification) will be necessary.
   • For s9(4): If relying on inability to obtain appropriate clinical management, collate evidence of attempts to obtain care, responses from health services, dates of referral, waiting lists, and clinician statements as to why appropriate care was not received and the consequence for clinical worsening.

4. Link the factor to relevant service:

   • Show that the activity identified in s9 or the inability to obtain management was related to the person’s relevant service as defined in Schedule 1. Service records, unit orders, deployment rosters, and contemporaneous training documents will be central to connecting the factor to operational, peacekeeping, hazardous, British nuclear test defence service, warlike or non‑warlike service categories (Schedule 1 relevant service list).

5. For clinical worsening scenarios, verify the pre‑existence rule:

   • If invoking clinical worsening (the worsening aspects of factors in s9), ensure the person’s condition was suffered or contracted before or during, but did not arise out of, the relevant service (s10(2)). Medical records predating service or contemporaneous documentation will be needed to establish the pre‑existing condition.

6. Where overlap exists, check other Statements of Principles:

   • If any factor you intend to rely upon refers to an injury or disease that is already covered by a different Statement of Principles, identify that instrument and apply its terms, as required by s11. Obtain the other Statement and follow its specified factors where applicable.

7. Quantification and expert input:

   • Use clinical experts to quantify compartment pressure findings and tie subjective symptoms to objective measures where available. Use exercise physiology or occupational‑health experts to translate described activities into MET values if the activity is not one of the examples in Note 1. The Schedule 1 MET conversion is the authoritative metric; provide expert reports that map the claimant’s activity to that metric.

8. Document excluded pathologies:

   • Obtain evidence excluding the listed alternative diagnoses where appropriate. If another diagnosis is present, record whether it is a comorbid or alternative explanation, because s7(2)(a) excludes certain pathologies from the Statement’s scope.

9. Prepare for contested claims:

   • Anticipate that adjudicators will compare the evidence against the precise thresholds in s9. Provide contemporaneous evidence where possible rather than retrospective affidavits alone. Where contemporaneous evidence is unavailable, be prepared to explain gaps and corroborate with unit records and medical notes.

10. Keep commencement and repeal dates in mind:

• The instrument commenced on 28 November 2023 (s2) and repealed the earlier shin splints Statement (s4). For claims straddling the commencement date, check administrative guidance from the department to determine which Statement applies and whether transitional arrangements exist.

11. For death claims, establish causal contribution:

• If the claim involves death, assemble medical evidence showing the chronic exertional compartment syndrome contributed to the terminal event listed in Schedule 1. Documentation must link the syndrome to the terminal event as a contributing cause, not merely the occurrence of the terminal event.

12. Administrative presentations:

• When preparing the claim, structure submissions around the s9 factors. Start with a clear statement of which s9 factor is relied upon, cite the pertinent diagnostic and activity evidence, and then show the nexus to relevant service as required by s10(1).

Following these steps will align submissions with the instrument’s explicit textual requirements. The Statement is framed in precise numerical and temporal terms, and compliance in practice requires documentary proof tied to those thresholds and to the Schedule 1 definitions.