Statement of Principles concerning complex regional pain syndrome (Reasonable Hypothesis) (No. 97 of 2016)

The instrument organises around a core set of medical and causal concepts that decision‑makers must apply to claims. Those concepts are defined and constrained within the instrument; the Schedule supplies the cross‑references and the meaning of terms used in the operative provisions (see Schedule 1).

Complex regional pain syndrome (CRPS): The instrument defines CRPS by clinical criteria (s6(2)). The definition has three discrete requirement tiers: continuing pain disproportionate to any inciting event (s6(2)(a)); at least one symptom in two of four categories (sensory; vasomotor; sudomotor/oedema; motor/trophic) (s6(2)(b)); and at least one observable sign at the time of evaluation in two or more of the same four categories (s6(2)(c)). The categories are listed in s6(2)(b)-(c)(i)-(iv) and identify specific symptom/sign types (for example, hyperalgesia or allodynia for sensory; temperature asymmetry for vasomotor; oedema or sweating changes for sudomotor; decreased range of motion or motor dysfunction for motor/trophic).

Death from CRPS: The instrument treats death from CRPS as including deaths where CRPS contributed to a terminal event or condition (s6(3)). Terminal event is defined in the Schedule to include causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function (Schedule: terminal event).

Relevant service: The instrument is expressly limited to claims tied to relevant service as defined in the Schedule (Schedule: relevant service). That definition lists operational service, peacekeeping service, hazardous service, British nuclear test defence service under the VEA, and warlike or non‑warlike service under the MRCA. The RMA frames its view that sound medical‑scientific evidence exists connecting CRPS to relevant service and death from it (s7).

Factors raising a reasonable hypothesis: Section 8 lists the factors that must exist, at least in part, to raise a reasonable hypothesis linking CRPS (or death from CRPS) to relevant service. Key features of these factors include (a) temporal windows (the six months before clinical onset in ss8(1)-(3)); (b) anatomical specification (the pain must originate in the region of the affected peripheral nerve or region of the injury/disease/surgery as stated in ss8(1)-(3)); (c) a pharmacological agent , phenobarbital , identified in s8(4) as relevant if the person was being treated with it at clinical onset; and (d) a systems factor, inability to obtain appropriate clinical management, in s8(5), with a restricted application set out in s9(2).

Interaction with other Statements: Section 10 creates cross‑instrument dependency. If a factor in s8 refers to an injury or disease that is the subject of another Statement of Principles made under s196B(2) VEA, then the factors in that other Statement apply according to its terms as in force from time to time. The Schedule also supplies a “specified list of injuries or diseases” that may trigger s8(2), and that list includes explicit named conditions (eg, fracture, herpes zoster, spinal cord injury) and a residual category for "any other injury or disease which causes acute tissue damage" (Schedule: specified list).

Reasonable hypothesis standard: The instrument’s operational phrase is that the factors listed "must as a minimum exist before it can be said that a reasonable hypothesis has been raised" (s8 introductory wording). That places the instrument within the VEA/MRCA causation framework where SoPs inform whether the statutory threshold of a reasonable hypothesis linking condition and service is met.

Claimants: The instrument directly affects individuals making claims under provisions of the VEA and MRCA where section 120A of the VEA or section 338 of the MRCA applies (s4). Those persons are described in the Schedule as veterans, members of Peacekeeping Forces, or members of the Forces per the VEA and MRCA categories listed under "relevant service" (Schedule: relevant service). A claimant whose diagnosis or death implicates CRPS and who seeks recognition that the condition is connected to relevant service will be assessed against this Statement of Principles.

Decision‑makers and administrators: The primary institutional addressee is the Repatriation Medical Authority itself as the author (s3), but the instrument is designed for use by decision‑making bodies that adjudicate entitlements under the VEA and MRCA. While the instrument does not directly name the Department or decision‑maker, the opening and s4 locate its application in the statutory claims processes where s120A VEA or s338 MRCA are engaged. Those decision‑makers will use the instrument to determine whether a reasonable hypothesis exists that CRPS is related to service.

Treating clinicians and independent medical examiners: The instrument prescribes clinical criteria and timing that will shape the evidence decision‑makers require. Treating doctors and independent assessors will need to record signs and symptoms in the terms used by s6(2) and to link injuries, surgeries, or treatments to the clinical onset of CRPS within the windows set out in s8. The instrument therefore affects the type and granularity of clinical documentation that claimants will be expected to produce.

Legal and advocacy representatives: Lawyers and advocates advising claimants or representing agencies will rely on the instrument to identify which clinical elements and temporal facts must be established to raise a reasonable hypothesis. They will be responsible for compiling medical records evidencing the specified factors in s8 and demonstrating the relationship to relevant service per s9.

Other Statement of Principles authors and users: Section 10 creates an interactional constituency: other Statements of Principles determined under subsection 196B(2) of the VEA affect the application of this instrument where s8 refers to an injury or disease that is the subject of another SoP. This means authors of other SoPs, and users of those SoPs, are implicated in combined assessments.

Who does not fall within the instrument: The instrument applies only where the claim engages s120A VEA or s338 MRCA (s4) and where the person’s service is within the Schedule’s definition of relevant service. It does not purport to operate outside the statutory claims processes referenced, and it does not itself confer benefits to non‑service persons.

This Statement of Principles does not create statutory offences or financial entitlements by itself; instead it prescribes medical criteria and causal factors that the RMA has determined must exist to raise a reasonable hypothesis linking CRPS to relevant service. The operative duties and rights created or implicated by the instrument therefore arise through how it is used in the VEA and MRCA administrative schemes.

Duty to apply the instrument in covered claims: The instrument is made "under subsection 196B(2) of the VEA" (s3) and applies to claims to which s120A VEA or s338 MRCA apply (s4). Decision‑makers who adjudicate such claims have a duty, in practice, to consider the RMA’s Statement when assessing whether the reasonable hypothesis test is satisfied. The instrument specifies the minimal factors (s8) and the definition of CRPS (s6) that must be evaluated; failure to apply these criteria would be a failure to use the instrument in the legally prescribed assessment framework.

Duty to demonstrate specified factors: For claimants, the instrument makes clear that at least one of the factors in s8 must exist "before it can be said that a reasonable hypothesis has been raised" (s8). Practically, this imposes an evidentiary duty on claimants to provide medical evidence consistent with the listed factors: proof of injury or disease involving a major peripheral nerve within six months before clinical onset and pain originating in the relevant region (s8(1)); proof that one of the specified list of injuries or diseases occurred within six months before clinical onset with pain originating in the affected region (s8(2)); proof of surgery within six months before clinical onset, with pain originating in the surgical region (s8(3)); documentation of phenobarbital treatment at the time of clinical onset (s8(4)); or evidence substantiating inability to obtain appropriate clinical management (s8(5)). Each of these is a discrete evidentiary pathway.

Duty to link factors to relevant service: Any factor in s8 "must be related to the relevant service rendered by the person" (s9(1)). The decision that a factor exists is not sufficient on its own; there is an additional relational step. This places an evidentiary and logical duty on claimants and adjudicators to connect the event (for example, an injury or surgery) to the person's relevant service as defined in the Schedule.

Rights in cross‑referenced SoPs: Where s8 refers to an injury or disease covered by another Statement of Principles made under s196B(2) VEA, s10 requires that the factors in that other Statement apply "in accordance with the terms of that Statement of Principles as in force from time to time." That gives procedural clarity and the right for parties to rely on the current terms of those other SoPs when the factor invokes them.

Limitations and constrained application: Section 9(2) restricts the application of s8(5) (inability to obtain appropriate clinical management). It applies only to material contribution to, or aggravation of, CRPS where the person’s CRPS was suffered or contracted before or during, but did not arise out of, the person's relevant service. The instrument thereby narrows the claims pathway which uses inability to obtain management as the causal factor, reducing the scope in which s8(5) can be invoked.

Right to have a reasonable hypothesis considered: The instrument operationalises what must be present for a reasonable hypothesis to be raised. Parties therefore have the right to expect adjudicators to assess the existence of the listed factors and their relation to relevant service when determining whether the reasonable hypothesis threshold is met. The instrument provides the substantive touchstones for that assessment.

No penalty provisions in the instrument: The instrument itself contains no penalties, criminal sanctions, or monetary assessments. It is a medical statement used within statutory claims processes. Any duties, obligations, or rights that translate into financial or service outcomes are mediated through the VEA or MRCA decision‑making provisions referenced (s4; s3).

The Statement of Principles instrument contains no express breaches, sanctions, penalty regimes, or enforcement mechanisms within its text. Its legal effect is procedural and evidentiary rather than punitive. The document functions as a medical standard to be applied by the relevant decision‑makers under the VEA and MRCA. The instrument therefore does not directly impose civil penalties or criminal sanctions; rather, the consequences of applying the instrument lie in the administrative findings it informs when a claim is determined under the statutory frameworks referenced in s4.

How enforcement occurs in practice: Enforcement, to the extent relevant, is carried out via the administrative claims process under the VEA and MRCA. The instrument is made under subsection 196B(2) VEA (s3) and applies to claims where s120A VEA or s338 MRCA apply (s4). Decision‑makers assess medical evidence in light of the instrument’s criteria; if the criteria set out in s6 and s8 are not met and no reasonable hypothesis is raised connecting CRPS to service, then administrative entitlements tied to a positive causation finding are less likely to be granted. Conversely, meeting the instrument’s minimum factors may allow the claimant to benefit from the presumption created by the reasonable hypothesis standard in the VEA or MRCA context. The instrument itself contains no direct enforcement or compliance penalty provisions.

Administrative review and appeal: The instrument does not describe or modify appeal routes, merits review, judicial review, or other processes by which decisions made under the VEA or MRCA might be challenged. Those procedural remedies are located in the VEA and MRCA frameworks; this SoP simply provides medical criteria to be applied within those frameworks. The instrument does not impose procedural burdens beyond specifying the medical facts that must be considered.

Operational compliance obligations: The principal operational effect for enforcement is evidentiary. Decision‑makers will require claimants to produce medical records, diagnoses, surgical notes, prescription records (for phenobarbital), and documentation showing inability to obtain appropriate clinical management where that factor is relied upon (s8). There is no statutory penalty contained in this instrument for failing to produce such evidence; the practical consequence is the claim may not satisfy the reasonable hypothesis threshold.

No delegated enforcement powers created: The instrument does not create new administrative powers such as inspection, compulsory production of documents, or investigatory coercion. It is a determination of the RMA of the medical evidence that indicates a link may exist; enforcement actions, if any, arise from the substantive provisions and dispute resolution mechanisms of the VEA and MRCA, not from the SoP itself.

Statutory basis and application: The instrument is made under subsection 196B(2) of the VEA (s3) and expressly applies to claims to which s120A of the VEA or s338 of the MRCA applies (s4). It therefore operates within the existing statutory architecture of the VEA and MRCA. The SoP functions as a technical medical instrument that decision‑makers apply when testing whether the statutory causation threshold (the reasonable hypothesis standard found in the VEA/MRCA framework) is met.

Cross‑reference to other Statements of Principles: Section 10 creates a direct interaction with other Statements of Principles determined under subsection 196B(2) of the VEA. When a factor in s8 refers to an injury or disease for which there is another SoP, the factors in that other SoP apply "in accordance with the terms of that Statement of Principles as in force from time to time." This has two concrete legal implications: (1) the assessment of certain factors requires reference not only to this instrument but to the current terms of other SoPs; and (2) those other SoPs’ amendments, while possibly made at different times, will affect how s8 operates because s10 imports their terms "as in force from time to time."

Definitional alignment with VEA and MRCA: The Schedule defines "relevant service" by reference to categories within the VEA and MRCA (Schedule: relevant service). That aligns the instrument’s scope with other statutory definitions in those Acts. The instrument also identifies MRCA and VEA as terms in the Schedule, ensuring internal consistency with the parent statutes. It does not, however, modify the substantive provisions of the VEA or MRCA; it supplies the RMA’s medical view for use in adjudicating causation under those Acts.

No override of statutory entitlements: The instrument does not purport to create, modify, or extinguish entitlements directly; it is a medical instrument informing whether entitlements under VEA and MRCA ought to be awarded based on causation. The instrument must be read as supplementary to the legal standards and procedural rules in the VEA and MRCA.

Implications for evidence rules and procedural steps: Because the instrument prescribes specific clinical and temporal criteria (s6; s8), it interacts with procedural rules on evidence collection, admissibility, and evaluation that apply under VEA and MRCA decision processes. Decision‑makers will need to assess documentary and expert medical evidence against the instrument. The instrument’s six‑month windows and anatomical origin requirements (s8) interact with the evidentiary burdens placed on claimants by the broader statutes and the administrative procedures under which claims are decided.

Terminal event and death claims: The Schedule defines terminal event (Schedule: terminal event) to include causes such as pneumonia and respiratory failure. Section 6(3) expands CRPS to include death from a terminal event contributed to by CRPS. This interacts with death and dependency provisions in VEA and MRCA insofar as a claimant seeks recognition that death was related to service via CRPS; decision‑makers must consider the Schedule’s terminal event concept when adjudicating such claims.

No direct interaction with criminal or employment law: The instrument makes no reference to criminal penalties, workplace safety statutes, or employment compensation regimes. It operates strictly within the veteran/forces compensation and rehabilitation context defined by the VEA and MRCA.

The instrument itself records its identification and dates: it is Statement of Principles No. 97 of 2016 concerning complex regional pain syndrome (Reasonable Hypothesis), dated 28 October 2016, and it commenced on 28 November 2016 (opening pages; s2). It is made under subsection 196B(2) of the VEA (s3). The instrument does not contain an internal chronology of prior versions, nor does it record amendments, revocations, or supersession of earlier Statements within its text.

What the document records concretely:

• Instrument determination date: 28 October 2016 (cover page).
• Commencement date: 28 November 2016 (s2).
• Instrument number and title: Statement of Principles concerning complex regional pain syndrome (Reasonable Hypothesis) (No. 97 of 2016) (cover page; s1).

Absence of amendment history in the instrument: The text contains no express amendment notes, no provision listing prior Statements that it supersedes, and no schedules of changes. It does, however, make provision for linkage to other SoPs by reference (s10), and it imports the notion that those other SoPs apply "as in force from time to time," which implies that the authorising framework contemplates future amendments to associated SoPs. The instrument itself is silent on whether and how it might be amended, and provides no transitional or savings provisions concerning earlier determinations.

Practical consequence of the record: For an adviser or decision‑maker citing the instrument, the operative dates are the determination date and the commencement date. Any subsequent amendments to this Statement would need to be located in later instruments or notices; none are recorded in the text supplied. Similarly, the instrument’s cross‑referencing language (s10) requires users to check the current versions of related SoPs to understand how they interact, because the instrument expressly imports those SoPs "as in force from time to time."

Administrative processes for amendment (contextual observation based on the text): The instrument is made under subsection 196B(2) VEA (s3), the statutory mechanism by which the RMA determines Statements of Principles. While the instrument provides no internal amendment history, the legislative mechanism under which it is made contemplates that the RMA may determine, revise, or repeal SoPs later; any such changes would appear as separate instruments and should be checked by users relying on the SoP.

The text of this Statement of Principles contains no litigation history, no citations to case law, and no references to judicial decisions. It is an administrative medical determination prepared by the Repatriation Medical Authority and recorded as an instrument (cover page; s3). The instrument does not narrate or summarise any judicial consideration of the SoP, nor does it contain annexed decisions or precedent citations.

What the instrument does show about potential litigation context: The instrument is framed to supply medical criteria that assist in reaching a legal standard , the reasonable hypothesis test , which is used in adjudicating claims under the VEA and MRCA (s4). While the instrument itself does not cite case law, it is intended to be used within statutory decision frameworks where decisions are subject to administrative review and judicial review processes under the parent Acts. Any litigation histories, appellate decisions, or judicial interpretations of this instrument would need to be sourced from the databases or materials recording decisions under the VEA and MRCA. The instrument itself contains no such record.

Implication for practitioners: Because the instrument includes no litigation history or interpretative guidance from courts, practitioners should treat the SoP as a primary RMA medical determination and look to VEA/MRCA administrative decisions and any subsequent judicial rulings elsewhere for interpretative development. The document does not provide precedential case law or examples illustrating how the criteria have been applied in contested cases.

No recorded challenge or judicial consideration in the text: The absence of litigation material in the instrument is explicit; nothing in the instrument purports to summarise or reproduce case outcomes or to incorporate judicial glosses. Users must therefore not rely on the instrument alone for understanding how courts might construe its criteria; they must consult relevant decision records outside the instrument for litigation history and authoritative judicial interpretation.

The instrument contains several technical features and limitations that can produce material risk points in claim preparation and decision‑making. These are mechanically grounded in the text; practitioners should note these as concrete caveats rather than policy judgements.

Temporal windows and clinical onset: Sections 8(1)-(3) require certain initiating events (major peripheral nerve injury/disease; a specified list of injuries/diseases; surgery) to have occurred in the six months before the clinical onset of CRPS, and the pain must originate in the region affected (s8(1)-(3)). This six‑month window is an explicit constraint that can be decisive. Documentation failing to show the timing of the initiating event relative to clinical onset may prevent the raising of the reasonable hypothesis. The instrument therefore imposes a tight temporal evidentiary burden on claimants.

Anatomical origin requirement: The factors in ss8(1)-(3) require that "the pain originates in the region" of the affected peripheral nerve, injury/disease, or surgical procedure (s8(1)-(3)). If the claimant’s pain is remote from the documented injury or surgical site, the factor will not apply even if the injury or surgery otherwise occurred within the six‑month window. This anatomical specificity is a substantial limiting feature and a frequent source of dispute.

Symptom and sign thresholds: The definition of CRPS in s6(2) requires both continuing pain disproportionate to an inciting event and at least one symptom in two categories plus at least one sign at evaluation in two categories (s6(2)(a)-(c)). Two practical consequences follow: (1) medical reports must document both reported symptoms and objectively observed signs in the categories listed; and (2) the "at the time of evaluation" requirement for signs means the timing of clinical assessment matters , a report that documents only historical signs or symptoms may not satisfy s6(2)(c). Failure to provide contemporaneous clinical signs may undermine a causation finding.

Narrow operation of inability to obtain management (s8(5) and s9(2)): The inability to obtain appropriate clinical management (s8(5)) might appear to be a broad systemic factor. However, s9(2) limits its application: s8(5) only applies to material contribution or aggravation where the CRPS was suffered or contracted before or during, but did not arise out of, the person's relevant service. That means s8(5) cannot be used to found a service connection where CRPS arose out of the person’s service; it is limited to situations involving exacerbation or material contribution to pre‑existing CRPS linked to inability to obtain management during relevant service. This nuance is a common "gotcha" if not carefully attended to.

Phenobarbital specificity: Section 8(4) enumerates a single pharmacological agent , phenobarbital , as a relevant treatment at the time of clinical onset. If a claimant received other sedative or anticonvulsant agents, s8(4) would not capture that. The instrument’s specificity may therefore exclude many medication histories that are clinically relevant but not phenobarbital specifically.

Residual "acute tissue damage" catch‑all: The Schedule’s specified list (Schedule: specified list of injuries or diseases) includes a general residual category "any other injury or disease which causes acute tissue damage" (Schedule). While that broad phrasing might appear to be inclusive, its application is still constrained by the six‑month timing and anatomical origin requirements in s8(2). It also raises questions for adjudicators about what constitutes "acute tissue damage" in borderline cases.

Cross‑SoP dependence: Section 10 imports the factors from other Statements of Principles "as in force from time to time" when s8 refers to an injury or disease covered by another SoP. This means claim assessment can require checking multiple instruments and the current versions of those instruments. There is a risk that practitioners may fail to apply a later amendment to an indexed SoP, or to identify which SoP governs a particular referred injury, creating procedural errors or inconsistent application.

No penalty or procedural guidance in the instrument: The SoP does not specify how to resolve conflicting medical evidence, what weight to give to various reports, or procedural steps required to test the reasonable hypothesis. Those procedural contours lie in the VEA/MRCA frameworks and administrative practice, so practitioners must coordinate the SoP’s medical thresholds with procedural requirements elsewhere.

Death claims and terminal event definition: For death connected to CRPS, s6(3) includes death from a terminal event "that was contributed to by the person's complex regional pain syndrome." The Schedule defines terminal events in terms of proximate or ultimate causes (such as pneumonia or respiratory failure). Proving that CRPS contributed to such terminal events can be complex and will commonly require causal medical opinions linking functional impairment from CRPS to susceptibility to the terminal event. The instrument itself does not provide evidentiary rules for establishing that contribution.

This instrument is a checklist of medical and relational facts decision‑makers will look for when a claimant relies on CRPS in a claim under the VEA or MRCA. Compliance is therefore an evidentiary and documentation exercise. Below are practice steps derived directly from the instrument’s text; each step cites the relevant provisions to make the compliance tasks concrete.

1. Confirm statutory coverage and applicability (s4; Schedule: relevant service)

   • Verify that the claim engages section 120A VEA or section 338 MRCA (s4).
   • Confirm the claimant’s service falls within the Schedule’s definition of "relevant service" (operational, peacekeeping, hazardous, British nuclear test defence under the VEA, or warlike/non‑warlike under the MRCA).

2. Establish a diagnosis of CRPS that satisfies s6(2)

   • Ensure medical reports document continuing pain disproportionate to any inciting event (s6(2)(a)).
   • Obtain records showing at least one symptom in two of the four categories listed (sensory; vasomotor; sudomotor/oedema; motor/trophic) (s6(2)(b)).
   • Obtain clinical examinations that show at least one sign at the time of evaluation in two or more of the same categories (s6(2)(c)). Emphasise contemporaneous objective findings (eg, hyperalgesia on pinprick, temperature asymmetry, oedema, decreased range of motion).

3. Establish the timing of clinical onset relative to initiating events (s8)

   • For s8(1)-(3) pathways, document that the injury/disease or surgery occurred within six months prior to the clinical onset of CRPS (s8(1)-(3)). Provide dates and sequential records showing onset dates and the dates of the listed events.
   • For s8(1), show evidence of an injury or disease involving a major peripheral nerve and that the pain originates in the region of that peripheral nerve.
   • For s8(2), if relying on a specified injury or disease, ensure it is one of the listed conditions in the Schedule or falls within "any other injury or disease which causes acute tissue damage" and that the pain originates in the affected region.
   • For s8(3), if relying on surgery, document the nature and site of the procedure and show that the pain originated in the surgical region.

4. Document pharmacological treatment where relevant (s8(4))

   • If relying on s8(4), obtain prescription records or treatment notes confirming phenobarbital treatment at the time of clinical onset. Note the instrument names phenobarbital specifically.

5. Document service‑related inability to obtain care where relevant (s8(5) and s9(2))

   • If relying on inability to obtain appropriate clinical management, collect contemporaneous records showing attempts to obtain care and the barriers encountered.
   • Remember s9(2) restricts the application of s8(5) to situations where the person’s CRPS was suffered or contracted before or during, but did not arise out of, their relevant service. Ensure factual narratives and records support that specific chronology and legal nexus.

6. Establish relation to relevant service (s9(1))

   • Beyond proving a factor in s8 exists, prepare evidence linking that factor to the person’s relevant service. That may include service records, medical treatment received in theatre or during service, timelines connecting an event on service to subsequent clinical onset, or contemporaneous notes showing symptoms manifested in or shortly after service.

7. If a factor refers to another SoP, apply that SoP (s10)

   • Identify whether any injury or disease relied upon is the subject of another Statement of Principles made under s196B(2) VEA. If so, retrieve the current version of that other SoP and apply its factors “as in force from time to time” (s10).
   • Document compliance with those cross‑SoP requirements in the claim file.

8. For death claims, document contribution to terminal events (s6(3) and Schedule: terminal event)

   • Where the claim is for death from CRPS, obtain medical cause of death documentation and expert opinions linking CRPS to the terminal event cited in the Schedule (for example, pneumonia or respiratory failure).
   • Demonstrate that CRPS materially contributed to the terminal event rather than being merely temporally associated.

9. Prepare for contested points of timing and anatomical origin

   • Anticipate disputes over whether pain "originates in the region" of the initiating event and collect clinical narratives and objective findings to tie pain location to injury/surgery/nerve region.
   • Provide sequence charts showing the date of injury/surgery, dates of medical attendance, onset of CRPS symptoms, and dates of clinical signs.

10. Record and cite the instrument metadata in submissions

• When making or defending a claim, cite the Statement of Principles accurately: Statement of Principles concerning complex regional pain syndrome (Reasonable Hypothesis) (No. 97 of 2016), determined under subsection 196B(2) VEA, dated 28 October 2016, commenced 28 November 2016 (see cover page; s1; s2; s3). Doing so ensures the adjudicator applies the correct instrument.

11. Maintain contemporaneous clinical and service records

• Because the SoP’s operative requirements hinge on exact timing, anatomical origin, and contemporaneous signs, the single best compliance measure is to secure and preserve detailed clinical notes, imaging, operative reports, prescription records, and service medical records. These form the evidentiary basis for satisfying the factors in s8 and the relational requirement in s9.

12. Cross‑check for amendments or related SoPs

• Although this instrument contains no amendment history in its text, s10’s cross‑SoP rule requires checking the current status of other Statements of Principles. Ensure you are using the current texts and consult administrative sources to confirm there have been no later determinations that alter the interplay with this SoP.

Following these steps aligns evidence collection and argumentation with the precise thresholds the RMA has set out. The instrument’s principal compliance demands are tight timing, precise anatomical linkage, contemporaneous signs, and clear relation to relevant service.