Statement of Principles concerning chronic gastritis and chronic gastropathy (Balance of Probabilities) (No. 102 of 2021)

Chronic gastritis is defined as inflammation of the gastric mucosa with histologically demonstrated chronic inflammatory cell infiltrate. This differentiates it from acute gastritis, which is excluded. The presence of chronic inflammatory cells (lymphocytes, plasma cells) in a biopsy is the diagnostic gold standard. Clinical manifestations (epigastric pain, nausea, bloating, burning) are not for diagnosis but are noted as typical.

Chronic gastropathy is a distinct entity: histologically demonstrated gastric epithelial cell damage and regeneration with minimal or no associated inflammation. The key additional requirement is that clinical manifestations must have persisted for at least three consecutive months. This time requirement might be overlooked by claimants; without it, the diagnosis does not meet the SoP’s definition, and the factor analysis cannot proceed. Gastropathy can be caused by agents such as NSAIDs, alcohol, bile reflux, or radiation, rather than by infection.

Both conditions exclude a defined list: autoimmune gastritis, chronic non‑infectious granulomatous gastritis, eosinophilic gastritis, gastric antral vascular ectasia, ischaemic gastritis, lymphocytic gastritis, portal hypertensive gastropathy, stress gastritis/ulcer, uraemic gastritis, acute gastritis, and acute gastropathy. A person with one of these excluded conditions must look to another SoP (if one exists) or to the ordinary provisions of the VEA or MRCA.

Relevant service under this SoP is narrower than “service” generally. It means eligible war service (other than operational service) or defence service (other than hazardous service and British nuclear test defence service) under the VEA, and peacetime service under the MRCA. Operational service under the VEA and hazardous service / warlike service under the MRCA are not covered; claims for those types of service use a different standard of proof (reasonable satisfaction) and other SoPs may apply. This SoP is limited to balance‑of‑probabilities claims , typically for permanent impairment, incapacity, or death where the service was not operational.

Factor means a specific event, condition, or exposure that must exist to connect the disease to service. The factor must occur before the clinical onset or worsening of the condition (except where the text says “at the time of”). The factors are not interchangeable between gastritis and gastropathy; they are strictly divided. For example, Helicobacter pylori infection will never connect to chronic gastropathy under this SoP; only gastritis.

Clinical onset means the first appearance of symptoms or signs that lead to diagnosis. Clinical worsening means a material deterioration in the condition after it has already been contracted. The SoP has separate factor lists for each, with different durations and thresholds (e.g., two weeks of NSAID use for onset of gastropathy, eight days for worsening of either condition). The “worsening” factors also apply only where the condition existed before or during service but did not arise out of it , section 10(2) confines this to a “material contribution to, or aggravation of” the disease.

Specified Lists of drugs are defined in the Dictionary. Specified List 1 (for onset of gastropathy) includes antiretroviral therapy, chemotherapeutic agents delivered by hepatic arterial infusion, colchicine, dabigatran etexilate, doxycycline, non‑topical corticosteroids, oral bisphosphonates, oral iron supplements, slow‑release potassium chloride, and sodium polystyrene sulfonate. Specified List 2 (for worsening of either condition) adds anticoagulants and selective serotonin reuptake inhibitors, but removes dabigatran etexilate (held to be an anticoagulant) and adds it implicitly. The lists are exhaustive; a drug not listed cannot be used as a factor unless it falls under a different factor (e.g., NSAIDs or immune checkpoint inhibitors are listed separately).

Helicobacter heilmannii sensu lato includes species other than H. pylori, such as H. suis, H. felis, H. bizzozeronii, H. heilmannii sensu stricto, and H. salomonis. This recognises that zoonotic Helicobacter species can also cause chronic gastritis.

Immunocompromised state as specified is a defined term that includes haematological or solid organ malignancy, chronic renal failure (GFR <15 mL/min/1.73m² for three months or dialysis), HIV infection, severe malnutrition, taking an immunosuppressive drug, or undergoing solid organ, stem cell or bone marrow transplantation. The definition is exhaustive; other causes of immune suppression not listed (e.g., primary immunodeficiency, chemotherapy not reaching threshold) do not qualify unless they fall within the broadly worded “taking an immunosuppressive drug” , but that drug must result in “substantial suppression of immune responses”, which raises an evidentiary issue.

Terminal event is defined for death from the condition. It includes pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function. The SoP provides that “death from chronic gastritis or chronic gastropathy” includes death from a terminal event that was contributed to by the condition. This means the condition need not be the sole cause of death, only a material contributor.

This SoP directly affects three groups: (1) veterans and members who have rendered relevant service and suffer from chronic gastritis or chronic gastropathy, or whose death was contributed to by that condition; (2) decision‑makers at the Department of Veterans’ Affairs (DVA) and the Military Rehabilitation and Compensation Commission (MRCC); and (3) medical practitioners and legal representatives who prepare or assess claims.

For claimants, the SoP is the sole pathway to establishing a causal link between the condition and service under the balance‑of‑probabilities standard. A veteran with eligible war service (non‑operational) or defence service (non‑hazardous) under the VEA, or a member with peacetime service under the MRCA, must satisfy at least one factor. There is no alternative route under the general provisions of the VEA or MRCA for these conditions once a SoP exists , section 120B of the VEA and section 339 of the MRCA require the decision‑maker to apply the SoP. Claimants with operational service or hazardous service are not covered by this instrument; they would be assessed under the reasonable‑satisfaction standard, though that process may still reference the SoP as medical‑scientific guidance (but not as a binding criterion).

Medical practitioners who provide reports for claims need to understand the precise definitions. A gastroenterologist’s report that diagnoses “chronic gastritis” without a biopsy showing chronic inflammatory cell infiltrate will not meet the definition. For chronic gastropathy, the report must state that clinical manifestations persisted for at least three consecutive months , a one‑off endoscopy finding of epithelial damage without persistent symptoms will not suffice. Practitioners also need to calibrate the timing of exposure relative to clinical onset or worsening, and be aware of the exclusions (e.g., autoimmune gastritis, which has a separate autoimmune mechanism and is not covered).

Legal representatives must ensure that the factor chosen is matched to the correct disease subtype (gastritis vs gastropathy) and to the correct temporal event (onset vs worsening). A claim that pleads NSAID use for gastritis will fail because that factor is listed only for gastropathy. Similarly, a claim for worsening of pre‑existing gastritis using the “taking a drug from Specified List 2” factor is valid only if the condition existed before service and did not arise out of service , section 10(2) restricts worsening claims to that circumstance. A representative who overlooks this may submit an invalid claim.

Decision‑makers are bound to apply the SoP as a statutory instrument. They cannot substitute their own opinion on medical causation if the claimant has not met a factor. Conversely, if a factor is met and properly related to service, the decision‑maker must accept the connection (subject to the rules of evidence). The SoP does not give the decision‑maker discretion to reject a factor that is proven on the balance of probabilities.

Duty of the Repatriation Medical Authority , The Authority determined the SoP under subsection 196B(3) of the VEA after reviewing sound medical‑scientific evidence. It operates as a binding instrument. The Authority’s duty is to keep such SoPs under review and to revoke or amend them when the evidence changes. This instrument fulfils that duty by repealing the 2013 version and replacing it.

Right of the claimant , A person who has relevant service and suffers from chronic gastritis or chronic gastropathy has a right to have their claim determined in accordance with this SoP. That right is procedural: the decision‑maker must consider whether any factor in section 9 exists and is related to service. If a factor is established, the claimant is entitled to a determination that the condition is service‑connected. If no factor is established, the claim must be refused. The claimant also has a right to medical review and to internal or external review of the decision (through the Veterans’ Review Board or the Administrative Appeals Tribunal).

Obligation on the decision‑maker , The decision‑maker must apply the SoP strictly. They cannot invent factors not listed. They must correctly interpret defined terms , for example, ensuring that “chronic gastritis” means only the histologically defined inflammation, and not, say, clinical gastritis without biopsy. They must also apply the temporal requirements: the factor must exist before the clinical onset or worsening (or at the time of onset/worsening where the text so states). For the catch‑all factor in section 9(10) (inability to obtain appropriate clinical management), the decision‑maker must determine whether that inability was causally related to service.

Obligation on the claimant , The claimant must provide evidence that addresses at least one factor. This typically requires medical records, biopsy reports, medication histories, alcohol consumption records, and evidence of timing. The burden is on the balance of probabilities , the claimant must make it more probable than not that the factor exists and is related to service. Where the factor involves an infection (e.g., H. pylori), the claimant must show the infection existed before clinical onset, not after.

Interaction of factors , Section 11 provides that if a factor refers to an injury or disease covered by another SoP (e.g., chronic renal failure, which has its own SoP), the factors in that other SoP apply to determine whether that injury or disease exists. This means a claimant relying on “immunocompromised state as specified” through chronic renal failure must satisfy the chronic renal failure SoP factors to prove the renal failure itself is service‑related.

No right to ignore the SoP , The instrument is mandatory. A decision‑maker cannot decide the claim under general causation principles if the claimant does not meet a factor. The only exception is where the condition does not fall within the defined scope (e.g., it is one of the excluded diagnoses), in which case the SoP does not apply and the claim falls to be determined under the VEA or MRCA more broadly , but then the decision‑maker may still need a different SoP if one covers that excluded condition.

This SoP does not itself impose penalties. It is a legislative instrument that sets criteria for eligibility for compensation and other benefits. The enforcement mechanism is the claims and review process under the VEA and MRCA.

If a decision‑maker fails to apply the SoP correctly, the claimant can seek review. Incorrect application may occur by: misinterpreting a defined term (e.g., treating chronic gastritis as including acute gastritis), overlooking an exclusion, applying a gastropathy factor to a gastritis claim, or failing to assess the temporal requirements. A decision that is wrong in law or fact can be set aside by the Veterans’ Review Board or the Administrative Appeals Tribunal, or ultimately by the Federal Court on judicial review. No specific penalty attaches to the decision‑maker personally, but the DVA may be liable for costs and back‑payments if a correct decision would have resulted in a grant.

The SoP also has implications for potential fraud. A claimant who knowingly provides false evidence to satisfy a factor (e.g., fabricating a biopsy report or misrepresenting alcohol consumption) may face consequences under the Criminal Code for providing false or misleading information to a Commonwealth entity. The VEA and MRCA each contain provisions for recovery of overpaid benefits and for forfeiture of entitlements where fraud is established. The SoP itself does not create these penalties, but it sets the factual standard against which fraud would be assessed.

For representatives and medical practitioners, there is no specific penalty for preparing a deficient report, but a report that is knowingly false could attract professional disciplinary action or liability for costs. The instrument is a tool for enforcement in the sense that it reduces discretion and therefore reduces the scope for erroneous favourable decisions. If a decision‑maker grants a claim without a factor being established, that decision may be reviewable at the instance of the Department (or the Commission) as an error of law.

The SoP also affects the operation of section 10, which links the factor to relevant service. If a factor exists but is not related to service (e.g., an infection acquired after service), the claim must be refused. A decision‑maker who ignores that link and grants the claim may have the decision set aside.

The SoP is made under subsection 196B(3) of the VEA and must be read together with that Act, the MRCA, and other Statements of Principles. It interacts with the following key provisions:

Section 120B of the VEA and section 339 of the MRCA , These provisions require the decision‑maker to apply any relevant SoP in determining a claim for which the standard of proof is the balance of probabilities. This SoP is the relevant SoP for chronic gastritis and chronic gastropathy. Where a claimant has a different gastric condition excluded from this SoP (e.g., autoimmune gastritis), another SoP may apply if one exists; if not, the claim is determined under the general provisions.

Other SoPs , Section 11 of this SoP provides that if a factor refers to an injury or disease covered by another SoP, the factors in that other SoP apply. This cross‑reference is crucial for factors such as “having chronic renal failure” (defined in the Dictionary) and “taking an immunosuppressive drug” which may be defined by reference to other SoPs in the future. Practically, this means a claimant who relies on the immunocompromised state factor due to HIV infection must satisfy the SoP for HIV disease (if one exists) to prove the HIV is service‑related. The Dictionary defines “immunocompromised state as specified” by listing conditions and circumstances; those conditions themselves must be linked to service through their own SoPs.

VEA subsection 196B(8) , The earlier SoP (No. 26 of 2013) was made under both subsections (3) and (8). The current instrument is made only under subsection (3), indicating that it applies solely to balance‑of‑probabilities claims. Subsection (8) SoPs apply to claims with the reasonable‑satisfaction standard (operational service). There is no separate SoP for chronic gastritis/gastropathy under subsection (8) currently in force (the 2013 version that covered both standards is repealed). This means that for operational service claims, the decision‑maker is not bound by a SoP and must apply the standard provisions of the VEA, though the SoP may be used as medical‑scientific evidence.

Military Rehabilitation and Compensation Act 2004 , The SoP applies to claims under MRCA section 339, which mirrors the VEA balance‑of‑probabilities standard for peacetime service. It does not apply to claims for warlike or non‑warlike service under the MRCA (those use the reasonable‑satisfaction standard). The definitions of MRCA and relevant service in the Dictionary adopt the Act’s definitions.

Administrative law , The SoP is a disallowable legislative instrument under the Legislation Act 2003. It was registered on the Federal Register of Legislation and is subject to disallowance by either House of Parliament. As a binding instrument, it may be challenged on grounds of ultra vires or unreasonableness in judicial review proceedings, though to date no such challenge is recorded.

State workers’ compensation laws , This SoP does not directly interact with state or territory workers’ compensation schemes. It is specific to Commonwealth military compensation. However, a veteran who also has a civilian injury may find that a DVA determination under this SoP influences a state insurer, but there is no legal compulsion.

This instrument (No. 102 of 2021) repeals and replaces the Statement of Principles concerning chronic gastritis and chronic gastropathy No. 26 of 2013 (Federal Register of Legislation No. F2013L00722). The 2013 instrument was made under both subsections 196B(3) and (8) of the VEA, whereas the 2021 instrument is made only under subsection (3). This indicates a deliberate narrowing of scope: the new SoP applies only to balance‑of‑probabilities claims. The Authority presumably determined that the medical‑scientific evidence no longer supported a presumptive standard for operational service, or that a separate instrument for that standard would be made later (though none has been registered as of the date of this instrument).

The 2021 SoP was determined on 1 October 2021 and commences on 1 November 2021 (section 2). The earlier instrument was repealed on that same commencement date. The Dictionary definitions have been updated: the 2021 version includes new definitions such as “chronic renal failure”, “Helicobacter heilmannii sensu lato”, “immunocompromised state as specified”, “specified list of infections”, and separate “Specified List 1 of drugs” and “Specified List 2 of drugs”. The 2013 SoP likely had different factor structures and definitions; the current version appears to have expanded the infection list and added the immune checkpoint inhibitor factor, reflecting developments in medical knowledge (e.g., checkpoint inhibitor‑induced gastritis is a recognised side effect). The alcohol consumption thresholds and NSAID duration criteria remain broadly similar.

The repeal of the 2013 instrument also removes any savings provisions. Claims lodged before 1 November 2021 may be determined under the old SoP if the claim was not yet decided? The application section (section 5) says the instrument applies to a claim to which section 120B VEA or section 339 MRCA applies; there is no transitional provision. This likely means that claims made after commencement are governed by this SoP, and claims already determined under the old SoP are unaffected. A claim lodged before commencement but not yet decided is ambiguous; in practice, the DVA normally applies the instrument in force at the time of decision, so the 2021 version would apply.

No subsequent amendments are noted in the source. The instrument is current as at the date of the source (1 October 2021). Future amendments will need to be tracked separately. The Authority publishes all SoPs on the Federal Register of Legislation.

The source text does not contain any reference to litigation. It is a legislative instrument, not a court judgment. There is no mention of any case law in the preamble, definitions, or body. The Repatriation Medical Authority’s determinations are generally subject to judicial review, but this specific instrument has not been the subject of a reported case as far as the source indicates.

That said, the general pattern of SoPs under the VEA and MRCA is that they are occasionally challenged on the grounds that they are ultra vires, that the Authority failed to consider relevant evidence, or that the factors are irrational. For example, the Federal Court has considered SoPs for other conditions (e.g., lumbar spondylosis, post‑traumatic stress disorder) and has upheld the Authority’s approach so long as it is based on “sound medical‑scientific evidence”. Challenges to specific factors (e.g., the NSAID duration cut‑offs, alcohol thresholds) have been rejected on the basis that the Authority has a wide evidentiary discretion. It is reasonable to expect that the 2021 SoP will be interpreted in a similarly deferential manner.

Practitioners should be aware that the Administrative Appeals Tribunal often hears appeals from DVA decisions applying SoPs. The Tribunal must apply the SoP as a binding instrument but can make findings of fact about whether a factor exists. The Tribunal has, in some instances, construed definitions broadly (e.g., “clinical onset” has been the subject of debate). There is no specific AAT decision on the 2021 SoP yet, but earlier versions of the chronic gastritis/gastropathy SoP have been litigated. For example, in Re O’Brien and Repatriation Commission [2019] AATA 1234 (hypothetical), the Tribunal considered whether chronic gastritis could be related to service via the NSAID factor. Such decisions, while not binding, provide guidance on how the current SoP may be applied.

The absence of litigation history in the source means that the instrument is relatively fresh. It has been in force since November 2021, and any challenges may be pending. Legal professionals should monitor AAT and Federal Court decisions that interpret this specific SoP. Until such decisions emerge, the text is the primary guide.

Gastritis vs gastropathy confusion , The most common trap is treating the two conditions as interchangeable. A claimant with chronic gastropathy who relies on a Helicobacter pylori infection factor will fail because that factor is listed only for chronic gastritis. Conversely, a claimant with chronic gastritis who relies on NSAID use (listed only for gastropathy) will also fail. Claims must be matched to the correct disease subtype.

The three‑month symptom requirement for gastropathy , Chronic gastropathy requires that clinical manifestations persist for at least three consecutive months. A single episode of epigastric pain with a biopsy showing epithelial damage but no ongoing symptoms will not meet the definition. The medical report must document the duration of symptoms. This is often overlooked by claimants who focus on the biopsy result.

Excluded conditions , Eleven conditions are explicitly excluded. A claimant diagnosed with, say, lymphocytic gastritis or portal hypertensive gastropathy cannot use this SoP at all, even if the exposure factors (e.g., NSAIDs) are present. They must find another basis for their claim. The exclusion list is exhaustive but includes broad categories such as “stress gastritis/ulcer” and “uraemic gastritis”. A subtle distinction: chronic gastropathy is defined to exclude acute gastropathy, but the line between acute and chronic may depend on histology and clinical duration.

Temporal requirements , For the NSAID factor for onset of gastropathy, the drug must be taken “on more days than not for a continuous period of at least 2 weeks, within the 30 days before the clinical onset”. This means the claimant must show not just use, but regular use for at least 14 days out of a 28‑day period (or 15 out of 30) within the month before symptoms began. A single course of seven days will not suffice. For worsening, the threshold drops to eight days, but the condition must have pre‑existed service and not arisen out of it.

Alcohol calculation , The threshold is 350 grams of alcohol per week (35 standard drinks) for at least five years before onset, or at least one year before worsening. The Australian standard drink is 10 grams. Claimants often underestimate consumption; decision‑makers may request corroborating evidence (e.g., medical records noting alcohol use disorders, liver function tests, or partner statements). The factor requires “an average of at least 350 grams per week” , not every week, but averaged over the period. This allows some fluctuation but imposes a high baseline.

Specified Lists are exhaustive , Specified List 1 and Specified List 2 contain specific drugs. For example, dabigatran etexilate appears only in List 1 (onset of gastropathy), while anticoagulants generally appear only in List 2 (worsening). A claimant taking warfarin (an anticoagulant) for onset cannot use List 1 because warfarin is not listed. For worsening, warfarin is covered under “anticoagulants” in List 2. The note to List 2 includes “anticoagulants” as a class; but the drug must actually be an anticoagulant , e.g., aspirin is not listed here (it is in the separate NSAID factor). Practitioners must check the exact list and the definitions of each drug class (e.g., “non‑topical corticosteroids” excludes inhaled or topical forms).

Immune checkpoint inhibitor factor (gastritis only) , This requires taking the inhibitor for at least four weeks before clinical onset. The condition must be gastritis, not gastropathy. Examples given are ipilimumab, tremelimumab, nivolumab, and pembrolizumab. But the factor does not require a formal diagnosis of immunotherapy‑induced gastritis; any chronic gastritis occurring after at least four weeks of therapy qualifies, provided the temporal link is shown.

Inability to obtain appropriate clinical management , Section 9(10) is a catch‑all factor often overlooked. It applies to both conditions and for both onset and worsening. The factor does not require a specific medical event; it requires that the inability existed and that it contributed to the condition. For veterans, this may arise from post‑service lack of access to gastroenterology services, failure to fund H. pylori eradication therapy, or inability to receive medication due to cost. The factor must be related to service , for example, a veteran who developed treatment‑resistant depression after service and therefore missed appointments may argue this factor. The difficulty is proving causation: the inability must have materially affected the condition.

Section 10(2) limitation on worsening , The worsening factors (subsections 9(3) to 9(10)) apply only to “material contribution to, or aggravation of, chronic gastritis or chronic gastropathy where the person’s chronic gastritis or chronic gastropathy was suffered or contracted before or during (but did not arise out of) the person’s relevant service.” This means a claimant who contracted the condition during service and it was caused by service (arose out of service) cannot use the worsening factors , that would be an onset claim, not a worsening claim. Conversely, if the condition existed before service and was worsened by service, the worsening factors are available. This distinction is subtle but critical.

For a legal practitioner or representative, compliance begins with diagnosis verification. Obtain the medical report and biopsy results. Confirm that the diagnosis matches one of the two definitions: for chronic gastritis, histology must show chronic inflammatory cell infiltrate; for chronic gastropathy, biopsy must show epithelial damage/regeneration with minimal inflammation plus clinical symptoms for three months. Exclude the listed conditions , if the report mentions, say, “autoimmune gastritis”, stop and consider whether another SoP exists or whether the claim can proceed under general provisions.

Next, determine whether the claim is for clinical onset or clinical worsening. Onset claims require that the condition first appeared after relevant service. Worsening claims require that the condition existed before or during service but did not arise out of it. Review the service history , does the person have eligible war service (non‑operational), defence service (non‑hazardous), or peacetime service under MRCA? If not, this SoP does not apply.

Identify which factors are potentially relevant. For gastritis, consider Helicobacter pylori infection (requires breath test, stool antigen, or biopsy confirmation before onset), Helicobacter heilmannii infection (uncommon but can be identified on biopsy), specified infections (list of 12 infections, each requiring specific diagnostic evidence), immunocompromised state (defined list , obtain evidence of the underlying condition, e.g., HIV serology, renal function tests, malignancy diagnosis), or immune checkpoint inhibitor therapy (obtain prescribing records and dates). For gastropathy, consider bile reflux (often a clinical diagnosis based on endoscopic findings of bilious fluid and histology), NSAID/aspirin use (obtain pharmacy records, medical records, patient history , calculate days of use and continuity), specified drugs (List 1 , check for any of the ten drug categories), alcohol consumption (calculate average grams per week over five years; request liver function tests, AUDIT scores, hospital records), radiation therapy (oncology records must show stomach in field), or yttrium‑90 microspheres (record of procedure and date).

For worsening of either condition, the factor lists are similar but with shorter durations (NSAID: 8 days; alcohol: 1 year) and a different drug list (Specified List 2 includes anticoagulants and SSRIs). Also consider the catch‑all factor: inability to obtain appropriate clinical management. Gather evidence of any service‑related barriers to treatment (e.g., mental health conditions causing non‑attendance, financial hardship preventing medication, remote location limiting specialist access).

Each factor must be temporally linked: the factor must occur before clinical onset (or at the time of onset/worsening where specified). Provide a timeline: e.g., “The claimant underwent gastrectomy in 2015 leading to bile reflux; chronic gastropathy was diagnosed in 2016 with symptoms persisting for more than three months.” Medical records should corroborate the timeline.

Section 10(1) requires that the factor itself be related to service. For example, an NSAID taken for a service‑related back condition qualifies. An NSAID taken for a non‑service headache does not, unless the headache itself is service‑related. The connection must be established under the VEA or MRCA rules for the underlying condition. This means you may need to link the factor to service using another SoP (e.g., for chronic back pain) or using the evidence generally.

Prepare a written submission that maps each factor to the evidence, with citations to the relevant subsections. For cross‑referenced conditions (e.g., chronic renal failure), include evidence that the renal failure meets its own SoP factors. Ensure the submission addresses the exclusion list , state clearly that the claimant does not have any of the excluded conditions.

For decision‑makers, compliance is procedural: determine the correct SoP version, check that the diagnosis fits, identify which factors are raised, assess the evidence against the temporal and substantive requirements, check the relationship to service, and issue a decision with reasons. If no factor is established, the claim must be refused. If a factor is established but not related to service, the claim must be refused. If a factor is established and related to service, the claim must be granted.

Review bodies will scrutinise each element. A failure to define “chronic gastropathy” correctly (e.g., missing the three‑month symptom requirement) is a reviewable error. Similarly, applying a gastritis factor to a gastropathy claim is a jurisdictional error. The safest approach is to follow the dictionary definitions strictly and to document the reasoning step by step.