Statement of Principles concerning chronic fatigue syndrome (Balance of Probabilities) (No. 106 of 2021)

The instrument rests on several interlinked legal-medical concepts stated in the text.

Diagnostic definition of CFS: Section 7(2) provides a working medical definition for the Statement. CFS means a syndrome of intense, prolonged fatigue meeting five discrete requirements: (a) new or definitive onset of severe fatigue not improved by bed rest and which may worsen with exertion; (b) fatigue persisted for at least six consecutive months and not due to ongoing exertion; (c) other mental or physical conditions associated with fatigue must be ruled out by a doctor and by any relevant diagnostic testing; (d) the fatigue significantly interferes with daily activities and work; and (e) concurrence of four or more of eight listed symptoms (post-exertion malaise >24 hours; unrefreshing sleep; impairment of short-term memory or concentration; muscle pain; joint pain without swelling or redness; new-type headaches; tender lymph nodes in neck or armpit; frequent or recurring sore throat). The instrument adds two notes: the additional symptoms must have persisted or recurred during six or more consecutive months of illness and cannot have first appeared before the fatigue (Note 1), and gives examples of other conditions associated with severe chronic fatigue that need to be ruled out (Note 2).

Death from CFS: Section 7(3) extends CFS in relation to a person to include death from a terminal event or condition that was contributed to by the person’s CFS. The Schedule defines “terminal event” broadly to include proximate or ultimate causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function.

Causation factors: Section 9 sets a gate: at least one of the listed factors must exist before it can be said, on the balance of probabilities, that CFS or death from CFS is connected with relevant service. The factors are narrow: an acute infection from a specified list at the time of clinical onset (s9(1)), or inability to obtain appropriate clinical management for CFS (s9(2)). The Schedule specifies the permitted infections as Coxiella burnetii (Q fever), Epstein-Barr virus (infectious mononucleosis), or Ross River virus.

Service relationship limits: Section 10 requires that any factor in s9 be related to the person’s relevant service. Critically, s10(2) imposes a limitation on the application of s9(2) (inability to obtain appropriate clinical management): that factor only applies to material contribution to, or aggravation of, CFS where the CFS was suffered or contracted before or during, but did not arise out of, the person’s relevant service.

Cross-reference to other Statements of Principles: Section 11 creates a mechanism to import factors from other Statements when a s9 factor refers to an injury or disease already covered by another Statement determined under s196B(3) of the VEA. Where this occurs, the factors in the other Statement apply in accordance with its terms as in force from time to time.

Probabilistic standard: The instrument is explicit that the causal link is to be assessed on the balance of probabilities. Section 8 states the RMA’s view on the medical‑scientific evidence available and s9 frames the threshold “before it can be said, on the balance of probabilities, chronic fatigue syndrome or death from chronic fatigue syndrome is connected with the circumstances of a person’s relevant service”.

Definitions and scope: The Schedule provides the operative definitions that determine scope, including what counts as “relevant service” (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), and the specified infections and terminal events already noted.

Together, these elements produce a tightly defined nexus instrument. The diagnostic test sets evidentiary requirements a clinician must meet; the causation factors are narrowly enumerated and limited in their application to service; and there is a mechanism to defer to other Statements of Principles where overlap exists. Each of those components constrains the ways in which claimants can establish a service connection for CFS under the VEA/MRCA pathways referenced in s5.

The instrument applies to individuals making claims under the specific statutory claim pathways referenced in the text: it applies to a claim to which section 120B of the VEA or section 339 of the MRCA applies (s5). The Schedule defines “relevant service” for the purposes of the instrument, limiting applicability to persons with eligible war service (other than operational service), defence service (other than hazardous service and British nuclear test defence service) under the VEA, or peacetime service under the MRCA (Schedule 1: relevant service). Therefore the primary affected population is persons whose service falls within those defined categories who make claims under the specified sections of the two Acts.

Claimants: Individuals alleging CFS or death from CFS as linked to their service must meet the diagnostic standard in s7(2) and show at least one of the causation factors in s9 that is related to their relevant service (s10(1)). Where a claimant seeks to rely on inability to obtain appropriate clinical management (s9(2)), s10(2) limits that factor to situations where the person’s CFS was suffered or contracted before or during relevant service but did not arise out of the service. That timing limitation will affect a subset of claimants who contracted CFS prior to, or during, service but whose initial contraction was not attributable to the service itself.

Clinicians and medical experts: The diagnostic and exclusion requirements in s7(2)(c) place a role on treating or certifying doctors to rule out other mental or physical conditions associated with fatigue by clinical assessment and diagnostic testing. The instrument’s formulation means medical evidence that engages the specified diagnostic criteria and the exclusion of listed alternative conditions will be central to claims. The Schedule also lists certain psychiatric, substance use and other conditions as illustrative examples of conditions associated with severe, chronic fatigue (Schedule 1 Note in s7(2)), indicating the types of alternative diagnoses that must be considered and excluded.

Decision-makers applying the VEA/MRCA provisions: While the instrument itself is not an adjudicative decision, it is a determinative Statement intended for use by decision-makers considering claims under the referenced statutory sections (s5). Those decision-makers will be required to apply the diagnostic standard and the causation factors set out here when evaluating whether, on the balance of probabilities, CFS or death from CFS is connected with relevant service. The RMA’s view on the medical‑scientific evidence underpinning the Statement is recorded in s8.

Other Statement-holders and cross-applicability: Where a causation factor in s9 refers to an injury or disease that is the subject of another Statement of Principles, s11 makes those other Statement provisions applicable in accordance with their terms. This affects parties and clinicians where a factor involves co-morbid or antecedent disease that has its own Statement; it creates a potential dependency on the content and currency of other Statements.

Absent parties: The instrument does not itself specify payers, compensation amounts, claims processes, administrative remedies or penalties. Those matters are governed by the VEA and MRCA provisions to which the instrument applies but are not contained in this instrument (see s3 and s5 for statutory context). The Schedule defines the technical terms that delimit the affected classes but does not expand the set of affected persons beyond the claim-eligible group defined.

In short, the instrument affects claimants with service falling into the defined “relevant service” categories who advance claims under the particular statutory sections cited, clinicians who must supply the diagnostic and exclusion evidence, and decision-makers who must apply this Statement in assessing nexus on the balance of probabilities. It does not on its face create entitlements, penalties, or payment mechanisms; those remain within the VEA and MRCA frameworks referenced (s3, s5).

The instrument prescribes no duties or rights in the form of obligations creating offences or direct entitlements; rather, it establishes evidentiary and definitional prerequisites that claimants and medical practitioners must meet for a causal nexus to be recognised, and it establishes the RMA’s view of the medical‑scientific basis for relating chronic fatigue syndrome and death from chronic fatigue syndrome to relevant service (s8).

Duty to meet diagnostic criteria: For CFS to be recognised under this Statement, the diagnostic requirements in s7(2) must be satisfied. Practically, this places an evidentiary duty on claimants to demonstrate, through medical reports and testing, that the five elements in s7(2)(a)-(e) are present. Section 7(2)(c) specifically requires that other mental or physical conditions associated with fatigue have been ruled out by a doctor and by any relevant diagnostic testing. That is an affirmative limiting condition embedded in the definition.

Duty to show at least one causation factor: Section 9 requires that before CFS or death from CFS can be said, on the balance of probabilities, to be connected with relevant service, at least one of the enumerated factors must exist. The claimant must adduce evidence that either: (1) an acute infection from the specified list was present at the time of clinical onset (s9(1)); or (2) there was an inability to obtain appropriate clinical management for CFS (s9(2)). The Schedule defines the narrow list of infections that can satisfy s9(1).

Duty to link factor to relevant service: Section 10(1) requires that any factor relied on under s9 be related to the person’s relevant service. That creates an evidentiary linkage duty: the factor must have a nexus to service. The instrument does not detail the forms of evidence that will suffice; it sets the requirement.

Limitation on reliance on inability to obtain care: Section 10(2) restricts the applicability of s9(2) so that it only applies to material contribution to, or aggravation of, CFS where the CFS was suffered or contracted before or during, but did not arise out of, the person’s relevant service. This is a particular legal constraint on how inability to access care interacts with timelines of service. It means a claimant whose CFS arose out of service may not be able to rely on s9(2) to establish material contribution or aggravation; the text expressly confines s9(2) to pre-existing or contemporaneous-but-not-arising-out-of-service cases.

Right to rely on cross-referenced Statements: Section 11 establishes that if a s9 factor refers to another injury or disease for which an RMA Statement exists, then the factors in that other Statement apply as in force from time to time. The effect is that claimants and decision-makers can invoke an interconnected body of Statements: reliance on a factor that points to another recognised disease will bring that disease’s Statement into play.

Standard of proof: The instrument frames the causal question as one of balance of probabilities. Section 8 records the RMA’s view that it is more probable than not that CFS and death from CFS can be related to relevant service, and s9 frames the threshold in terms of what must exist before it can be said, on the balance of probabilities, that CFS or death from CFS is connected with the circumstances of a person’s relevant service. The diagnostic and causation elements therefore operate within that probabilistic adjudicatory standard.

No penalty or enforcement provisions in the instrument: The instrument does not create offences, fines, administrative sanctions, or direct payment obligations. It is an evidentiary and definitional instrument. Duties and rights in the operational sense,such as entitlements to compensation or review rights,are not specified here; those remain within the broader VEA and MRCA frameworks to which this Statement applies (s3, s5).

In summary, the instrument makes certain evidentiary duties explicit for claimants and clinicians: meet the RMA’s diagnostic definition (s7(2)), establish at least one of the enumerated factors (s9), and show that the factor is related to relevant service (s10). It sets the standard of proof and provides a mechanism to incorporate other Statements where factors overlap (s11). It does not confer or spell out monetary entitlements, enforcement mechanisms, or administrative remedies within the instrument itself.

The Statement of Principles instrument contains no self-executing penalty provisions, criminal offences, or express enforcement mechanisms. Nowhere in the instrument does it create monetary penalties, regulatory sanctions, or administrative enforcement powers. The instrument is an RMA determination made under s196B(3) of the VEA (s3) and functions as a statement of medical causation standards rather than as an enforcement instrument.

Consequences for non-compliance with diagnostic elements: The only “sanction-like” consequential effect in practical terms derives from the evidentiary operation of the Statement. If a claimant cannot satisfy the diagnostic criteria in s7(2) (for example, cannot show at least six months’ duration, cannot show that other conditions have been ruled out by a doctor and testing, or cannot document the cluster of four or more listed symptoms), or cannot show at least one of the factors in s9 that is related to relevant service as required by s10, then the claimant will not satisfy the RMA’s conditions that, on the balance of probabilities, CFS or death from CFS is connected with relevant service. That evidentiary failure will affect the success of a claim under the VEA or MRCA pathways the Statement is intended to inform (see s5), but the instrument itself does not set out what administrative decision or remedy flows from such a failure.

No internal enforcement agency: The Statement does not designate an agency to enforce compliance with the diagnostic standards. Its operative function is to guide decision-makers applying the VEA and MRCA in assessing causation. Any enforcement or consequence (acceptance or rejection of a claim, entitlement to benefits, or administrative review rights) would derive from those Acts and the decision-making frameworks they provide, which are outside the text of this instrument.

Reliance on medical evidence and professional duty: Because the instrument requires that other conditions be ruled out by a doctor and by relevant diagnostic testing (s7(2)(c)), the instrument implicitly relies on clinicians to supply accurate, contemporaneous medical information. The instrument does not itself impose new regulatory responsibilities on clinicians, nor does it provide penalties for inaccurate reporting. The document prescribes how claim decisions should be informed, not how clinicians must act or be disciplined.

Repeal and transition: The instrument repeals the previous Statement of Principles concerning chronic fatigue syndrome No. 12 of 2014 (s4). The instrument does not set out transitional enforcement rules or retrospective penalty mechanisms for actions prior to the commencement date. It simply replaces the previous Statement as the operative RMA determination from its commencement on 22 November 2021 (s2).

In short, enforcement of the standards in this Statement occurs through application by decision-makers under the VEA and MRCA; the Statement itself provides the medical causation framework but does not create standalone penalties, enforcement agencies, or sanctions. Any consequences for failing to meet the standards are structural and evidentiary rather than penal in the instrument itself.

The instrument is made under the statutory power in s196B(3) of the Veterans' Entitlements Act 1986 (s3), and it explicitly ties its practical application to claims governed by the VEA and the Military Rehabilitation and Compensation Act 2004 (MRCA). Section 5 provides that the instrument applies to a claim to which s120B of the VEA or s339 of the MRCA applies. The instrument therefore operates as a subordinate medical determinative instrument within the statutory architecture of those Acts; it is intended to guide the assessment of causation within the claim processes established by the VEA and MRCA.

Definitions linking statutory schemes: The Schedule defines “VEA” and “MRCA” for the instrument’s purposes and defines “relevant service” by cross-reference to categories drawn from the VEA and MRCA (Schedule 1). The instrument’s applicability is therefore explicitly conditioned on a claimant’s service type as defined by the underlying statutes.

Cross-application with other Statements of Principles: Section 11 creates a legal mechanism for interaction with other RMA Statements of Principles. If a factor in s9 refers to an injury or disease that already has a Statement determined under s196B(3) of the VEA, then the factors in that other Statement apply in accordance with its terms as in force from time to time. That provision creates a chainable body of determinative documents: where a causation factor in this instrument overlaps with another disease or injury Statement, the other Statement’s content will be applied to that factor. That can import differing diagnostic standards, timing rules or factor lists from other Statements into the assessment of a particular claim.

Replacement of earlier instrument: Section 4 repeals the earlier Statement No. 12 of 2014. The repeal is an explicit interaction with the corpus of RMA instruments: it removes the prior Statement as the operative RMA determination for CFS and substitutes this instrument from its commencement date (s2). The instrument does not, however, set out transitional provisions in the body of the text; it simply records the repeal.

No direct amendment to VEA/MRCA text: The instrument does not amend the text of the VEA or the MRCA. It is a statutory instrument under s196B(3) of the VEA that supplies medical evidentiary guidance to be applied within the claim frameworks those Acts create. Any rights, obligations, decision-making procedures, review mechanisms or benefit entitlements remain governed by the VEA and the MRCA; this Statement informs how particular medical causation questions are to be assessed under those Acts.

Scope-limiting definitions: The Schedule’s definitions, such as “relevant service” and “specified list of infections”, narrow the universe of factual scenarios in which the Statement will operate. For example, s9(1) only accepts acute infection from a limited list of infections (Coxiella burnetii, Epstein-Barr virus, Ross River virus) as a qualifying factor. The instrument therefore interacts with other disease or infection laws or determinations only insofar as those topics are covered by other RMA Statements that can be applied under s11.

No cross-reference to criminal law, privacy law or administrative penalty provisions: The instrument contains no express references to other legal regimes (for example, criminal penalties, privacy obligations, or disciplinary procedures). Any interaction with those legal fields would arise from the VEA/MRCA claim handling or from general legal obligations on medical practitioners and decision-makers, but those interactions are not detailed in the instrument.

In summary, the instrument interacts with other laws primarily by operating as an RMA-made determinative instrument under the VEA, applying to claims under particular provisions of the VEA and MRCA (s5), repealing the earlier RMA Statement, and providing a mechanism in s11 to incorporate factors from other existing Statements. It does not itself amend the parent Acts nor set out interaction rules with other general laws beyond those described.

The instrument contains an explicit, limited amendment history within its text. It repeals the earlier Statement of Principles concerning chronic fatigue syndrome No. 12 of 2014 (Federal Register of Legislation No. F2014L00015) made under subsection 196B(3) of the VEA (s4). The instrument is dated 22 October 2021 and its commencement date is 22 November 2021 (s2). The text does not record any other amendments, variations, or prior versions beyond the named repeal.

Because the only recorded amendment is the repeal of the 2014 Statement, the 2021 instrument stands as the operative Statement of Principles for chronic fatigue syndrome from its commencement date, replacing the 2014 determinative Statement. The instrument does not specify transitional arrangements for claims initiated under the earlier instrument, nor does it set out savings provisions; it simply repeals the prior Statement and commences as stated (s2, s4). Any transitional application would therefore be determined by the decision-making frameworks of the parent Acts (VEA and MRCA), but those frameworks and transitional rules are not specified in this instrument.

The Schedule supplies definitions that renew or restate the RMA’s approach at the time of this instrument: notably, the specified list of infections in Schedule 1 is set out in the instrument (Coxiella burnetii, Epstein-Barr virus, Ross River virus). Those definitional choices implicitly amend the RMA’s previous approach to causation for CFS by narrowing the infectious agents that can be relied on under s9(1), compared with whatever content the 2014 Statement may have contained; however, the instrument text itself does not compare or detail the differences between the two instruments.

No subsequent amendments are recorded within the instrument’s text. The instrument does, however, provide for cross-application of other Statements of Principles “as in force from time to time” (s11), which creates an ongoing interactive mechanism whereby future amendments to other Statements could be incorporated by reference into causation analyses under this Statement. That is a present functional interaction but not an amendment to this instrument itself.

In short, the amendment history recorded in this instrument is limited: repeal of the 2014 Statement (s4), date of determination (22 October 2021) and commencement (22 November 2021) (s2). The textual choice to include a defined specified list of infections and the cross-reference clause in s11 are the main substantive features that differentiate the current Statement, but the instrument does not provide a running amendment log beyond the contained repeal.

The instrument contains no entries or material recording any litigation history. The document itself is a Statement of Principles made by the Repatriation Medical Authority under s196B(3) of the Veterans’ Entitlements Act 1986 (s3) and does not include or recount decisions, judicial proceedings, appeals or reviews involving the instrument or its predecessors.

The instrument does show that it replaces the earlier Statement of Principles concerning chronic fatigue syndrome No. 12 of 2014 (s4). The text does not indicate whether there were any legal challenges, court proceedings, or administrative appeals related to the 2014 instrument or to the making of this instrument. It does not record any judgments, determinations or litigation outcomes that cite or interpret the 2021 Statement.

Because the instrument is silent on litigation, the document itself provides no source-grounded material to describe cases, court interpretations, or appellate outcomes that bear on the legal effect or construction of the instrument. Any litigation history relevant to the interpretation, scope, or application of this Statement of Principles would need to be found in judicial records or administrative decision databases outside the text of this instrument; those records are not part of the instrument’s content.

Within the instrument’s own provisions, the only legal procedural statements are the statutory provenance (s3), the application to claims under s120B VEA or s339 MRCA (s5), the RMA’s expressed view on the medical-scientific evidence (s8), and the cross-application clause for other Statements of Principles (s11). None of those clauses contain or reference litigation outcomes.

Therefore, as far as the document itself is concerned, there is no litigation history to record. Any examination of legal disputes, challengeable aspects of the instrument, or contested applications of these criteria in claim determinations will require consultation of external judicial and administrative decision sources beyond this instrument’s text.

The Statement contains a number of textual constraints and technical features that can catch claimants and advisers if relied upon without attention to the instrument’s precise wording.

1. Narrow list of qualifying infections (s9(1); Schedule 1). The only infections that satisfy s9(1) are Coxiella burnetii (Q fever), Epstein-Barr virus (infectious mononucleosis), and Ross River virus. If a claimant asserts CFS onset associated with any other acute infection, the instrument does not accept that as a qualifying factor under s9(1). Advisers must therefore ensure any infection relied on is one of those three pathogens as defined in the Schedule.

2. Six-month persistence and symptom timing (s7(2)(b), s7(2)(e), Note 1). The diagnostic definition requires fatigue to have persisted for at least six consecutive months and that the additional symptoms have persisted or recurred during six or more consecutive months of illness. Moreover, additional symptoms cannot have first appeared before the fatigue. Claims based on shorter illness durations or where symptoms predate fatigue will not meet the instrument’s diagnostic threshold.

3. Exclusion of other causes required by a doctor and testing (s7(2)(c)). The instrument requires that other mental or physical conditions associated with fatigue be ruled out by a doctor and by any relevant diagnostic testing. The instrument itself lists examples of such conditions (depressive disorder, bipolar disorder, alcohol use disorder, substance use disorder, schizophrenia, eating disorders, dementia of any type and morbid obesity) as Note 2 in s7(2). This imposes an evidentiary burden on the claimant to produce specialist clinical assessment and testing demonstrating exclusion of alternative diagnoses. Absent such documented exclusion, the definition will not be met.

4. Limited role of inability to obtain care (s9(2), s10(2)). Although s9(2) permits “inability to obtain appropriate clinical management for chronic fatigue syndrome” to be a factor, s10(2) limits that factor’s application: it applies only to material contribution to, or aggravation of, CFS where the person’s CFS was suffered or contracted before or during, but did not arise out of, their relevant service. That is a precise temporal and causal limitation. If the CFS is alleged to have arisen out of service, s9(2) cannot be used to establish material contribution or aggravation. This is a frequent conceptual pitfall for claimants who assume lack of care during or after service always supports causation.

5. Requirement that factors be related to relevant service (s10(1)). Even where a qualifying factor under s9 exists, s10(1) requires that the factor be related to the person’s relevant service. The instrument does not describe the form of evidence sufficient to establish that relationship; claimants must therefore ensure documentary evidence links timing, exposure, or access-to-care issues to the period or circumstances of relevant service as defined in the Schedule.

6. Interaction with other Statements (s11). If a s9 factor refers to an injury or disease covered by another Statement of Principles, the factors in that Statement apply “in accordance with the terms of that Statement as in force from time to time”. That can create complexity where a causation factor triggers applicability of a different Statement with its own timing or evidentiary rules. Advisers should check for any interconnected Statements and their current terms; failing to do so may overlook additional requirements.

7. Death linkage requires contribution to terminal event (s7(3); Schedule 1 terminal event). For death from CFS, the instrument requires that the person’s CFS contributed to a terminal event or condition. The Schedule’s list of terminal events is illustrative and includes events like pneumonia and respiratory failure. Claimants must therefore show contribution, not merely the presence of CFS, to the terminal event. The instrument’s wording requires a causal contribution to the proximate or ultimate cause of death.

8. Balance of probabilities framing (s8, s9). The instrument is framed around the balance of probabilities standard. That means claimants must meet the probabilistic threshold using the RMA’s defined factors and diagnostic criteria. The instrument is explicit in that framework, so evidence planning must be tailored to persuade on probability rather than absolute proof.

9. No procedural detail or evidentiary list provided. The instrument states substantive medical thresholds and factors but does not specify procedures, forms, or administrative evidentiary checklists. Practitioners should not assume the instrument supplies process; it supplies substantive criteria only.

10. Repeal of the earlier Statement (s4). Because the 2014 instrument is repealed, earlier reliance on the old Statement’s language for historical cases may be misplaced. Any claim falling within the operative dates is subject to the current instrument from its commencement date (s2). Advisers should ensure that evidence presented aligns with the 2021 instrument’s terms.

Each of these points arises directly from the instrument’s text. They are specific operational constraints,narrow pathogen list, six-month duration, exclusion by a doctor and testing, the limited scope for inability-to-treat factor, and the cross-Statement mechanics,that can materially affect whether a given fact pattern is capable of establishing a service connection under this Statement.

The instrument does not prescribe procedural steps, but it sets substantive criteria that must be met. Compliance therefore means assembling medical and service evidence that maps onto the instrument’s diagnostic definition (s7), causation factors (s9), and service linkage requirements (s10). Practical steps consistent with the instrument’s text are as follows.

1. Establish the diagnostic elements in s7(2):

   • Document new or definitive onset of severe fatigue that is not improved by bed rest and may worsen with physical or mental exertion (s7(2)(a)).
   • Show that the fatigue persisted for at least six consecutive months and is not due to ongoing exertion (s7(2)(b)).
   • Obtain a medical report from a doctor that explicitly states other mental or physical conditions associated with fatigue have been ruled out, and include any relevant diagnostic testing records (s7(2)(c)). The instrument gives examples of conditions to be considered (Note 2 to s7(2)); ensure testing addresses those possibilities where clinically relevant.
   • Provide clinical evidence that the fatigue significantly interferes with daily activities and work (s7(2)(d)).
   • Record and document that the individual concurrently had four or more of the eight listed symptoms and that those symptoms persisted or recurred during at least six consecutive months of illness (s7(2)(e); Note 1).

2. Demonstrate at least one qualifying factor in s9:

   • If relying on s9(1), document an acute infection from the specified list (Coxiella burnetii, Epstein-Barr virus, Ross River virus) that was present at the time of the clinical onset of CFS (Schedule 1: specified list of infections and s9(1)). Laboratory confirmation, contemporaneous clinical records or diagnostic codes should be included where available.
   • If relying on s9(2) (inability to obtain appropriate clinical management), provide contemporaneous or retrospective evidence showing attempts to access appropriate clinical management and the barriers encountered. However, be mindful of the limitation in s10(2) (see step 3).

3. Tie factors to relevant service under s10:

   • Ensure any factor relied on under s9 is related to the claimant’s “relevant service” as defined in the Schedule (eligible war service other than operational service; defence service other than hazardous service and British nuclear test defence service; or peacetime service under the MRCA). Provide service records, dates of service, postings, and any medical encounters during service that link the qualifying infection or access-to-care problem to the period or circumstances of service (s10(1) and Schedule 1).
   • If relying on s9(2), confirm that the CFS was suffered or contracted before or during, but did not arise out of, the person’s relevant service. s10(2) limits the applicability of s9(2) to that factual pattern. Documentation should therefore show onset timing relative to service and explain causation chronology.

4. Consider cross-referenced Statements (s11):

   • If a s9 factor refers to an injury or disease for which another Statement of Principles exists, include evidence that addresses the factors required in that other Statement because s11 makes those factors applicable. Determine whether any such linked Statements exist and include the relevant medical evidence.

5. Present evidence framed to the balance of probabilities:

   • The instrument is explicit that causation is assessed on the balance of probabilities (s8, s9). Medical reports should therefore address the likelihood that the qualifying factor and its relationship to relevant service satisfy that probabilistic standard, explicitly linking clinical findings to service circumstances as required by the instrument.

6. Address death cases per s7(3) and Schedule:

   • For a claim involving death from CFS, show that the person’s CFS contributed to the terminal event or condition that caused death. Include death certificates, autopsy reports, clinical notes describing the role of CFS in the chain of events, and evidence that the terminal event matches the Schedule’s definition of terminal event if relevant.

7. Use treating doctors’ findings for exclusion and symptom persistence:

   • Because s7(2)(c) requires that other conditions be ruled out “by a doctor and by any relevant diagnostic testing,” include explicit statements from treating doctors who have undertaken or reviewed diagnostic testing and considered and excluded the listed alternative diagnoses where clinically appropriate.

8. Be aware of the instrument’s limits:

   • Do not attempt to rely on infections outside the Schedule for s9(1). Do not attempt to rely on inability to obtain care under s9(2) where the CFS is alleged to have arisen out of service; s10(2) excludes that pattern.

9. Maintain contemporaneous records:

   • The instrument’s timing and exclusion requirements make contemporaneous clinical records, laboratory tests and service records particularly important. Ensure clinical histories indicate onset dates, symptom duration, testing undertaken and outcomes, and any communications or attempts to access care if s9(2) is invoked.

10. Check for other relevant Statements and the current terms of those Statements:

• Because s11 brings in other Statements “as in force from time to time,” confirm the current text of any other Statements referenced by a s9 factor and ensure evidence addresses those Statements’ factors as required.

These compliance steps are derived from the instrument’s substantive text: diagnostic criteria (s7), causation factors (s9), relation-to-service requirement and limitation on s9(2) (s10), cross-application clause (s11), and the Schedule definitions. The instrument does not provide procedural checklists, timeframes for decision-making, or administrative forms; those procedural matters are governed by the VEA and MRCA claim processes to which this Statement applies (s5). Counsel and advisers should therefore structure evidentiary packages to map directly to the textual elements of this Statement of Principles.