Statement of Principles concerning clonorchiasis (Balance of Probabilities) (No. 26 of 2025)

The instrument embeds a small set of interlocking legal and medical concepts that decision-makers will use to determine service connection for clonorchiasis claims. These are the definitional, temporal and causal building blocks.

Definition of the condition: Clonorchiasis is given a precise clinical definition as an infestation of the biliary system by the trematode Clonorchis sinensis (s7(1)-(2)). The instrument also notes the ICD‑10‑AM code B66.1 is the code commonly applied to clonorchiasis but instructs that the statutory meaning is the textual definition in s7(2) (s7(2)-(3)). This separates coding practice from the legal definition.

Death causation: The Statement includes death from clonorchiasis as within scope where death is from a terminal event or condition that was contributed to by the person’s clonorchiasis (s7(4)). The Schedule defines “terminal event” in concrete terms, listing causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure, and cessation of brain function (Schedule 1, terminal event).

Standard of connection: The instrument is explicitly framed by the balance of probabilities standard in the Authority’s medical‑scientific view: the RMA states that, on the sound medical‑scientific evidence available, it is more probable than not that clonorchiasis and death from clonorchiasis can be related to relevant service (Basis, s8). The Statement therefore sets out factors which, if established and related to relevant service, support a finding of causal connection on the balance of probabilities.

Enumerated causal factors: The Statement sets two discrete factors, either of which must exist to meet the causation threshold (Factors, s9). The first is a specified exposure pathway: ingesting (by eating) the skin or flesh of freshwater fish prepared in particular ways , raw, undercooked, iced, pickled, or smoked , at least three weeks before clinical onset (s9(1)). The instrument also contains a note identifying countries where clonorchiasis is endemic, naming China, Korea, Russia, Taiwan, and Vietnam (note to s9). The second factor is a health‑system/management pathway: inability to obtain appropriate clinical management for clonorchiasis before clinical worsening (s9(2)).

Temporal and service nexus constraints: The relationship to relevant service is required for any listed factor to operate (s10(1)). Additionally, the s9(2) factor is limited to material contribution to, or aggravation of, clonorchiasis only where the person’s clonorchiasis was suffered or contracted before or during, but did not arise out of, the relevant service (s10(2)). This creates a temporal boundary and a causation distinction for the management‑related factor.

Cross‑application: If a factor in s9 refers to an injury or disease covered by another Statement of Principles, the other Statement applies in accordance with its terms as in force (s11). That mechanism allows overlap with other Statements without contradiction.

Definitions of legal categories: The Schedule defines “relevant service” in statutory terms: 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). It also defines MRCA and VEA by reference (Schedule 1).

These concepts combine to produce a structured assessment: diagnosis (by the s7 definition), an identified qualifying factor from s9, a temporal relationship between exposure and clinical onset (three weeks for s9(1)), and a nexus to relevant service (s10). The RMA’s Basis statement frames those requirements as sufficient, when established, to make it more probable than not that service is related to the condition (s8).

The instrument directly affects three groups, within the limits stated in the text.

1. Claimants under the VEA and MRCA regimes: The Statement applies to claims to which section 120B of the VEA or section 339 of the MRCA applies (Application, s5). That means veterans, eligible service members, or their dependants who lodge claims asserting that clonorchiasis or death from clonorchiasis is connected with relevant service will have their claims assessed with reference to this Statement. The Schedule defines “relevant service” narrowly to particular categories of eligible war service, defence service and peacetime service (Schedule 1). Therefore only persons whose service fits those statutory categories are in the instrument’s scope.

2. Decision‑makers and medical assessors: Administrative decision-makers within agencies that determine entitlements under the VEA and MRCA will be required to apply this Statement when considering causal connection for clonorchiasis claims (s5, s8, s9-s11). Medical officers and experts who provide evidence for claims will need to frame their opinions around the elements the Statement identifies: diagnosis per s7(2), timing (three weeks before clinical onset for s9(1)), inability to access clinical management where relied upon (s9(2)), and the service nexus (s10).

3. Service organisations and legal practitioners advising claimants: Lawyers, advocates and organisations supporting claimants will be affected because the Statement changes the factual and evidentiary threshold for demonstrating service connection. The repeal of the 2016 Statement (s4) means practitioners must rely on the new criteria in their claims and advice.

Indirectly affected groups include medical providers and record‑keepers: the two factors in s9 create evidentiary pressures. For ingestion claims (s9(1)), contemporaneous evidence of exposure or travel, deployment lists, unit histories, food provisioning records, witness statements, or personal accounts may be needed to anchor the ingestion to relevant service. For inability to obtain appropriate clinical management claims (s9(2)), the claimant will need to show service‑period constraints on accessing care and medical records showing clinical worsening attributable to lack of timely management, and expert opinion on material contribution or aggravation.

The Statement’s note identifying endemic countries (China, Korea, Russia, Taiwan, and Vietnam) is a factual pointer that may influence how exposure evidence is evaluated, but the Note is not itself a normative entitlement; the legal test remains the factors and their relation to relevant service (s9 note, s10). The instrument contains no express mention of beneficiaries beyond those with claims under the specified statutory provisions and makes no new financial commitments; it provides criteria for determining whether existing statutory entitlements are triggered (s5, s8).

The instrument itself is not an Act conferring new statutory rights in isolation; it functions as a determinative Statement of Principles to be applied under existing VEA and MRCA provisions. From the text, the following duties and rights emerge by operation of the instrument.

Rights or entitlements triggered by application:

• A claimant who demonstrates, on the balance of probabilities, that clonorchiasis or death from clonorchiasis meets the criteria in this Statement and that the relevant factor(s) is related to their relevant service may have that condition treated as related to service for the purposes of the VEA or MRCA. The instrument’s Basis expresses the RMA’s view that such a relationship can exist and defines the causal factors to be applied by decision-makers (s8, s9). The right to have a claim considered under these criteria flows from the instrument’s application to claims under s120B VEA or s339 MRCA (s5).

Duties imposed on decision-makers and assessors:

• Decision-makers considering VEA and MRCA claims that involve clonorchiasis must apply this Statement when determining whether the condition is service-related. The instrument’s application clause (s5) and the enumerated factors (s9) function as the operative test for causation. While the Statement does not prescribe procedural steps, it requires that at least one factor in s9 be established and that the factor be related to relevant service (s10(1)). This creates an obligation for decision-makers to assess those elements in each claim.

• For claims relying on the inability to obtain appropriate clinical management (s9(2)), decision-makers must address the temporal and causal limitation in s10(2): the management‑related factor applies only where clonorchiasis was suffered or contracted before or during, but did not arise out of, the relevant service. Decision-makers must therefore evaluate whether the condition arose out of service, or whether it pre-existed or was contracted before/during service, and whether inability to obtain management materially contributed to or aggravated the condition (s10(2)).

Evidentiary expectations implicit in the factors:

• The first factor requires evidence that ingestion of freshwater fish prepared in specified ways occurred at least three weeks before clinical onset (s9(1)). That imposes an evidential duty on claimants or their advisers to provide information on timing and mode of exposure sufficient to satisfy the three‑week threshold and to establish that the exposure is related to relevant service.

• The second factor requires evidence of inability to obtain appropriate clinical management prior to clinical worsening (s9(2)). This creates an evidentiary burden to show both lack of access to care and a causal link between that lack and clinical aggravation.

No penal liabilities created by the instrument:

• The Statement does not create criminal or civil penalties, nor does it set procedural sanctions. Its function is to define factors for causation in administrative determinations under the VEA and MRCA. There are no enforcement or penalty clauses in the instrument itself.

Relationship with other Statements:

• Where a factor in s9 refers to an injury or disease covered by another Statement of Principles, the other Statement’s factors apply according to that Statement’s terms in force from time to time (s11). Decision-makers thus have a duty to identify overlap and to apply the external Statement’s terms as appropriate.

Summarily, the instrument confers the right to have clonorchiasis and death from it assessed against an enumerated, evidence‑based causation test when claiming under s120B VEA or s339 MRCA, and imposes duties on decision-makers to apply those criteria, respect the temporal and causation limits in s10, and account for overlapping Statements per s11. The instrument does not itself alter payment or compensation mechanisms; it affects the gateway causal determination that influences entitlement outcomes under the existing statutory schemes (s5).

The Statement of Principles instrument contains no express criminal, civil or administrative penalty provisions. It is a technical, medical‑causation instrument made under subsection 196B(3) of the VEA; its role is to set evidentiary factors for administrative determinations under the VEA and MRCA. The text contains no enforcement mechanisms, fines, or sanctions. The relevant provisions of the instrument that reflect this absence are the operative clauses and Schedule, none of which provide for penal measures (see whole instrument).

Enforcement in the sense of practical application occurs through administrative decision-making within the VEA and MRCA frameworks. That means:

• The instrument is enforced through the processing of claims under section 120B of the VEA and section 339 of the MRCA (Application, s5). Decision-makers in the agencies administering those Acts will apply the Statement’s factors when deciding whether clonorchiasis is connected with relevant service. The instrument does not itself define the procedural mechanisms for how a claim is lodged, reviewed, appealed, or how findings are implemented; those procedural and enforcement mechanisms are contained in the VEA and MRCA and the administrative processes of the relevant agencies, not in this Statement.

• Where a factor in s9 refers to an injury or disease covered by another Statement of Principles, that other Statement applies in accordance with its own terms (s11). Any enforcement or procedural consequences tied to that other Statement are governed by its terms and the underlying Acts.

• There is no provision in this Statement imposing duties on third parties to produce records, to report, or to enforce compliance. Any evidentiary obligations rest on parties to claims and on decision-makers applying administrative standards.

• The absence of penalty clauses in the instrument means challenges to decision‑making outcomes will proceed through the statutory review and appeal pathways specified in the VEA and MRCA and by the administrative arrangement of the decision-maker, rather than through sanctions in the Statement itself.

In short, enforcement of this instrument is administrative and indirect: it operates by guiding entitlements decisions under the VEA and MRCA. The instrument imposes no standalone penalties and contains no enforcement provisions; its practical effect is realised through the exercise of decision-making power in the existing statutory frameworks (s5, s8-s11).

This Statement is expressly designed to be applied within the statutory architecture of the VEA and MRCA. The text contains several cross‑links and constraints that determine how it interacts with those Acts and with other Statements of Principles.

Direct statutory application:

• The instrument applies to claims to which section 120B of the VEA or section 339 of the MRCA applies (Application, s5). It is therefore not a freestanding entitlement; it must be used in the statutory context of those claim provisions. The precise procedural effects,how the Statement’s findings feed into payment, compensation or other benefits,are governed by the VEA and MRCA provisions themselves, not by this instrument.

Authority of the Repatriation Medical Authority:

• The instrument is made under subsection 196B(3) of the VEA (Authority, s3). That subsection is the statutory power by which the Repatriation Medical Authority sets Statements of Principles. The instrument thus sits as an authoritative medical statement under the VEA’s test for determining whether a disease or death is connected with service.

Interaction with other Statements of Principles:

• Section 11 creates an explicit interaction mechanism: if a factor in this Statement refers to an injury or disease covered by another Statement made under subsection 196B(3) of the VEA, the factors in that other Statement apply in accordance with the terms of that Statement as in force from time to time (s11). Practically, this means that overlap is resolved by deferring to the other Statement’s current terms, which may change over time. Decision-makers must therefore identify cross‑references and apply the contemporaneous terms of any referenced Statement.

Coding and classification:

• The Statement notes that clonorchiasis attracts ICD‑10‑AM code B66.1, and it identifies the edition and effective date of the ICD‑10‑AM it refers to (s7(2)-(3)). The instrument clarifies that the statutory meaning is the definition in s7(2), not the code per se. That means clinical coding systems and legal definitions are linked but not identical; decision-makers should treat the ICD code as a reference rather than as the sole determinant.

Definitions that interact with statutory categories:

• The Schedule defines “relevant service” for the purposes of this Statement to include certain categories under the VEA and MRCA (Schedule 1). That links the Statement’s application to the definitions in those Acts. For example, relevant service includes eligible war service (other than operational service) and defence service with exclusions (Schedule 1). Where statutory definitions in the VEA or MRCA are amended, the meaning of relevant service in practice will be affected by those amendments, because the Statement’s application depends on the statutory categories it references.

No modification of other legal obligations:

• The Statement does not purport to vary or displace duties in other Acts beyond providing the causal test for the VEA/MRCA claims. It does not create new criminal liabilities, administrative penalties, or reporting obligations that would interact with other statutes.

Temporal interaction and repeal:

• The instrument repeals the prior clonorchiasis Statement No. 48 of 2016 (s4). That repeal is a legal interaction: previously applicable criteria are removed and replaced by the new criteria. Decision-makers and claimants must therefore rely on this instrument for claims with relevant dates on or after its commencement, subject to any transitional rules in the VEA or MRCA (the Statement itself contains no transitional provisions).

In sum, the Statement operates as a statutory medical test to be applied under VEA and MRCA claim provisions, references clinical classification systems as a secondary aid, defers to other Statements when factors overlap (s11), and relies on statutory definitions of relevant service in Schedule 1. Its interactions with other laws are therefore confined to the VEA/MRCA framework and to other Statements made under the same subsection 196B(3) of the VEA.

The instrument records a limited amendment history as part of its core provisions. From the text, the following are the recorded changes and the legal authorship:

• Repeal of prior Statement: The instrument expressly repeals the Statement of Principles concerning clonorchiasis (Balance of Probabilities) (No. 48 of 2016) that was registered as Federal Register of Legislation No. F2016L00562 and made under subsection 196B(3) of the VEA (Repeal, s4). That is the sole repeal recorded in the text and represents the most direct amendment history: the 2016 Statement is removed from effect and replaced by the 2025 Statement.

• New instrument creation and commencement: The new Statement is made and dated 18 February 2025 by Professor Terence Campbell AM, Chairperson of the Repatriation Medical Authority, and it commences on 25 March 2025 (Name s1; Commencement s2; instrument front matter). The instrument is titled as No. 26 of 2025 (Name, s1). Those dated entries constitute the formal enactment and commencement data.

• Authority basis unchanged: The instrument is made under the same statutory provision used for prior Statements, subsection 196B(3) of the VEA (Authority, s3). The text does not purport to modify that enabling provision; it uses it as the legal basis for the Statement.

• No internal amendment provisions: The Statement contains no clauses providing for future amendment, transitional arrangements, or savings for claims assessed under the repealed 2016 Statement. It also contains no sunset clause. The text therefore implies that the 2016 Statement is replaced immediately on repeal and that this 2025 Statement stands as the operative instrument from its commencement date forward.

• Cross-references to other Statements: The instrument’s s11 provides that if a factor in s9 refers to an injury or disease covered by another Statement, the other Statement applies as in force from time to time. That provision creates a mechanism whereby changes to other Statements will affect how cross‑referencing factors operate in practice, but it does not itself record any prior amendment history.

Because the instrument is short and self-contained, its amendment history within the text is limited to the formal repeal of the 2016 Statement, the new instrument’s authorisation and dates, and the standard delegation to the enabling statute. There is no recorded chronology of revisions, consultations, or earlier drafts within the instrument itself. Any earlier or subsequent amendments to the VEA, MRCA or to other related Statements of Principles are not documented in this text and would need to be checked against the statutory records and the Federal Register of Legislation for a complete legislative history.

The instrument contains no litigation history. The text does not cite any judicial decisions, tribunal findings, or published appeals that concern the prior or current Statements of Principles for clonorchiasis. It contains no annotation of case law, no reference to legal challenges to similar Statements, and no record of litigation that led to the replacement of the 2016 Statement (Repeal, s4).

Practical consequences of that silence:

• Decision-makers and practitioners will need to derive application and interpretation from the instrument’s text, from the enabling statute (subsection 196B(3) of the VEA), and from the administrative frameworks of the VEA and MRCA. The absence of litigation citations in the instrument means there is no guidance within the Statement itself about how courts or tribunals have previously interpreted similar factors or how contested factual scenarios have been resolved.

• Where parties wish to test the Statement’s application in contested matters, review and appeal mechanisms available under the VEA and MRCA and the broader administrative law framework will be the avenues for litigation. The Statement does not record whether any prior disputes over the 2016 Statement were litigated, nor does it include interpretive notes that draw on judicial pronouncements.

• Because the Statement defers to other Statements where overlap exists (s11), litigation that engages those other Statements may indirectly affect how this Statement operates in practice. However, the instrument itself does not record such litigation.

For an authoritative account of any litigation that has engaged clonorchiasis claims, decision-makers, practitioners and researchers must consult tribunal and court records and review decisions made under the VEA and MRCA. The instrument provides no litigation precedents, and therefore its internal text must be read on its face for interpretive issues until and unless courts or tribunals authoritatively construe its provisions in adjudicated cases.

This Statement appears compact, but it contains several technical features and potential interpretive pitfalls that practitioners should note when preparing or determining claims. The following are concrete, source‑grounded points to watch.

1. Definition vs. ICD coding: The instrument records that clonorchiasis attracts ICD‑10‑AM code B66.1 (s7(2)), but it then specifies that the legal meaning for the Statement is the definition given in s7(2) , an infestation of the biliary system by Clonorchis sinensis (s7(1)-(2)). That means a clinical code alone is not the legal test; decision‑makers must ensure the clinical facts satisfy the textual definition in s7(2). Treat the ICD code as a reference, not a substitute for the statutory definition.

2. Time‑window for exposure: The ingestion factor requires that the person ingested the skin or flesh of freshwater fish prepared as listed (raw, undercooked, iced, pickled, or smoked), and that this ingestion occurred at least three weeks before clinical onset (s9(1)). The three‑week minimum is a specific temporal threshold. Claims that cannot show ingestion at least three weeks before onset will not meet s9(1)’s criterion, even if they show ingestion closer to onset.

3. Narrow exposure modes: The text lists specific modes of preparation , raw, undercooked, iced, pickled, or smoked freshwater fish (s9(1)). Other modes of exposure (for example, cooked fish clearly prepared well beyond “undercooked”) are not listed. Claimants and decision-makers must account for those specific descriptors; the Statement does not include a general “consumed freshwater fish” clause.

4. Service nexus requirement: Any factor in s9 must be related to relevant service (s10(1)). Establishing that an ingestion or inability to obtain management occurred is necessary but not sufficient; the factor must be connected to the person’s relevant service as that term is defined in Schedule 1. The Schedule narrows “relevant service” to particular categories (eligible war service other than operational service, defence service excluding hazardous and British nuclear test service, peacetime service under MRCA). This creates potential gaps where exposure occurred but not during service qualifying as “relevant service” (Schedule 1; s10(1)).

5. Restriction on s9(2): The inability to obtain appropriate clinical management factor (s9(2)) is limited by s10(2). It applies only to material contribution to, or aggravation of, clonorchiasis where the person’s clonorchiasis was suffered or contracted before or during, but did not arise out of, the person’s relevant service. In other words, s9(2) cannot be used to link newly contracted clonorchiasis that arose out of service; it is confined to situations where the condition pre‑existed or was contracted before or during service but not as a result of the service. That is a common point of confusion and a potential trap for claims that allege a lack of access to care as the primary causal mechanism for service‑arising illness.

6. Death causation and terminal events: The Statement covers death from clonorchiasis where the death stems from a terminal event or condition that was contributed to by clonorchiasis (s7(4)). The Schedule lists specific terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). Decision‑makers must map the decedent’s terminal events to the Schedule definition and then show clonorchiasis contributed to that terminal event.

7. Cross‑reference to other Statements: Section 11 provides that if a factor in s9 refers to another Statement, the other Statement’s factors apply as in force from time to time (s11). This can result in shifting application if the referenced Statement is amended. Practitioners must check not only this Statement but also any cross‑referenced Statements in their current form.

8. No procedural guidance or evidentiary rules: The Statement states the causal factors and the RMA’s basis (s8-s9) but contains no procedural directions on how evidence should be presented or evaluated. It does not specify documentary standards, expert qualifications, or evidentiary thresholds beyond the balance of probabilities. Administrative processes under the VEA/MRCA will govern evidence handling, which creates potential uncertainty and practice variation.

9. Geographic note is informational, not prescriptive: The Note to s9 lists countries where clonorchiasis is endemic (China, Korea, Russia, Taiwan, and Vietnam). That Note is informative but does not alter the statutory test; exposure in those countries may be probative, but lack of travel to those countries does not automatically preclude a finding where the s9 criteria are otherwise met.

10. Repeal effected without transitional language: The instrument repeals the 2016 Statement (s4) and contains no internal transitional provisions. For claims spanning the repeal or with clinical onset dates straddling the repeal, practitioners must consider how the enabling statute and departmental practice treat prior Statements; the Statement itself provides no transitional rules.

These items are not interpretive suggestions but direct consequences of the instrument’s text. They indicate areas where factual and evidentiary preparation must be precise to avoid denials based on timing, preparation mode, service nexus, or the limited operation of the inability‑to‑obtain‑management factor.

The instrument sets a focused causation test. Compliance in this context means assembling the medical, service and factual evidence that allows a decision-maker to conclude, on the balance of probabilities, that clonorchiasis or death from clonorchiasis is related to relevant service under the VEA or MRCA. The key compliance steps below are derived from the Statement’s text and Schedule.

1. Confirm the statutory framework and eligibility:

   • Establish that the claim is properly lodged under a provision to which this Statement applies: section 120B of the VEA or section 339 of the MRCA (Application, s5). If the claim sits outside those provisions, this Statement does not apply.
   • Confirm the claimant’s service falls within the Schedule’s definition of “relevant service”: eligible war service (other than operational service), defence service (excluding hazardous service and British nuclear test defence service), or peacetime service under the MRCA (Schedule 1). If the service category is disputed, obtain service records, deployment histories and, if necessary, authoritative service declarations.

2. Establish the diagnosis per the Statement:

   • Obtain medical evidence confirming clonorchiasis as an infestation of the biliary system by Clonorchis sinensis, consistent with s7(1)-(2). While ICD‑10‑AM code B66.1 is noted (s7(2)), ensure clinical documentation substantiates the s7(2) textual definition (imaging, laboratory parasitology, specialist opinion).
   • For death claims, document the terminal event and show how clonorchiasis contributed to it (s7(4) and Schedule 1 terminal event list). Obtain death certificates, hospital records and specialist opinions linking clonorchiasis to the terminal event.

3. Match the evidentiary pathway to a factor in s9:

   • If relying on s9(1) (ingestion), gather evidence that the person ingested skin or flesh of freshwater fish prepared as listed (raw, undercooked, iced, pickled, or smoked) and that this ingestion occurred at least three weeks before clinical onset. Evidence may include:

     • Personal statements or affidavits detailing what was eaten, preparations and timing relative to symptom onset.
     • Witness statements from contemporaries or unit members.
     • Travel and deployment records showing presence in environments where exposure occurred, including any detail linking food provisioning to freshwater fish consumption.
     • Medical records noting the reported history of ingestion and timelines.
     • Where relevant, supplementary proof of endemic exposure (the Statement’s Note lists endemic countries, which may support plausibility) (s9 note).

   • If relying on s9(2) (inability to obtain appropriate clinical management), collect evidence showing:

     • The person had clonorchiasis before or during relevant service, or contracted it before or during service, and that it did not arise out of the service (s10(2)).
     • Contemporaneous medical records indicating attempts to obtain or the inability to obtain appropriate care.
     • Documentation of health system constraints during service (clinic closures, lack of specialist access, timetabling, location‑based restrictions) where possible.
     • Expert medical opinion that the inability to obtain appropriate management before clinical worsening materially contributed to, or aggravated, the clonorchiasis. The expert should address timing, causal pathways and the magnitude of contribution.

4. Establish the relationship to relevant service:

   • For any factor relied upon, explicitly link the exposure or inability to obtain care to relevant service (s10(1)). Evidence may include:
     • Service diaries, unit orders, mess or supply records that indicate food sources or restrictions during service.
     • Records of where and when the claimant was posted or deployed, showing that ingestion or lack of treatment occurred in the course of relevant service.
     • Witness statements tying the exposure or failed access to clinical care directly to the service environment.

5. Prepare clear medical opinion addressing the Statement’s elements:

   • Obtain a written expert opinion that expressly addresses the elements of s7, s9 and s10. For ingestion, the expert should comment on whether the reported mode of preparation and timing is consistent with the clinical course (including the three‑week latency). For management failures, the expert should assess whether lack of timely treatment would, on the balance of probabilities, materially contribute to or aggravate the condition.
   • For death claims, the expert must address how clonorchiasis contributed to the terminal event(s) listed in the Schedule.

6. Anticipate cross‑statement issues:

   • If any factor touches an injury or disease covered by another Statement, identify that Statement and review it, because s11 makes the other Statement’s terms applicable as in force (s11). Provide evidence and expert opinion addressing both Statements if necessary.

7. Document timelines carefully:

   • Ensure all dates are clear: date(s) of ingestion, date of clinical onset, dates of service, and dates when attempts to access clinical management were made. The three‑week threshold for s9(1) is a precise temporal rule and requires explicit dates (s9(1)).

8. Address coding but prioritise the textual definition:

   • Include ICD coding if available (B66.1), but ensure medical evidence ties the diagnosis to the s7(2) definition. Decision-makers will note the ICD code but must apply the textual definition.

9. Recognise limitations on the s9(2) factor:

   • Do not rely on s9(2) to link a clonorchiasis that arose out of service to service. The instrument restricts the management factor to aggravation of pre-existing or pre-contracted clonorchiasis that did not arise out of the relevant service (s10(2)). If a claimant asserts that clonorchiasis arose out of service and that lack of treatment in service caused it, the s9(2) pathway will not, by its wording, be available.

10. Keep contemporaneous evidence at the forefront:

• Administrative decision-making relies on contemporaneous records where available. Where records are sparse, provide cogent explanations and supporting testimony to bridge gaps.

Following these steps aligns preparation and decision-making with the textual tests the Statement sets out (s7-s11). The Statement itself does not prescribe procedural mechanics; therefore practitioners must also follow the VEA and MRCA’s procedural rules for lodging, serving and reviewing claims. The Statement’s precise timing and causation thresholds should be addressed head-on in medical evidence and in claims narratives to avoid rejections predicated on timing, nexus, or the specific limitations of s9(2).