Statement of Principles concerning diaphragmatic hernia (Balance of Probabilities) (No. 100 of 2022)

The instrument structures its decision rule around a small number of core concepts drawn from the RMA’s assessment of medical‑scientific evidence. Those concepts define the condition, the causal standards, the qualifying factors, temporal limits and the relationship to service.

Definition of the condition

• Diaphragmatic hernia is defined as an acquired protrusion of intra-abdominal tissue through the diaphragm into the thoracic cavity (s 6(2)(a)). The instrument expressly excludes congenital diaphragmatic hernia, eventration of the diaphragm and hiatus hernia (s 6(2)(b)(i)-(iii)). This exclusion is structural: the Statement is limited to acquired defects with protrusion into the thoracic cavity, not congenital anomalies or hiatus hernia pathology.

Death from the condition

• The Statement treats death from diaphragmatic hernia as included where the person's death from a terminal event or condition was contributed to by the diaphragmatic hernia (s 6(3)). The Schedule defines “terminal event” as proximate or ultimate causes of death and lists examples such as pneumonia, respiratory failure, cardiac arrest, circulatory failure or cessation of brain function (Schedule 1, terminal event).

Standard of causation

• The RMA frames the causal test as balance of probabilities. Section 7 states that on the sound medical‑scientific evidence available, the RMA is of the view that it is more probable than not that diaphragmatic hernia and death from it can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA. The practical consequence is that the Statement identifies factual circumstances which, where established and related to relevant service, attain that balance.

Qualifying factors and timing concepts

• Section 8 sets out the discrete factors of causation or contribution. The instrument requires that at least one of those factors must exist before a service connection can be found. The factors include: surgery involving the affected diaphragmatic region (excluding the oesophageal hiatus) within ten years before clinical onset; acute trauma to the affected region before clinical onset; endometriosis involving the affected region before onset; analogous triggers before clinical worsening (s 8(1)-(6)); pregnancy within six weeks before clinical worsening (s 8(7)); and inability to obtain appropriate clinical management for diaphragmatic hernia (s 8(8)). The Schedule and notes attached to s 8 provide examples of surgical procedures and examples of acute trauma.

• The instrument distinguishes “clinical onset” and “clinical worsening”. Those temporal markers are the points to which some qualifying factors must be tied (s 8(1),(4) and (7) respectively). The instrument does not supply an exhaustive clinical definition of those terms; they operate as temporal landmarks in the RMA’s causal scheme.

Relationship to relevant service

• Section 9 requires that the existence of any factor in s 8 be related to the person's relevant service. “Relevant service” is defined in the Schedule and includes eligible war service (other than operational service) and defence service (other than hazardous service and British nuclear test defence service) under the VEA and peacetime service under the MRCA (Schedule 1, relevant service). Section 9(2) provides a further qualification limiting subsections 8(4)-(8) to material contribution or aggravation where the hernia was suffered or contracted before or during (but did not arise out of) relevant service.

Interaction with other Statements of Principles

• Section 10 creates an incorporation mechanism: where an s 8 factor refers to an injury or disease that is the subject of another Statement, the factors in that other Statement apply in accordance with its terms “as in force from time to time” (s 10). This produces a rule of cross-reference to other RMA determinations.

Administrative and evidentiary character

• The Statement is an administrative instrument of medical opinion. It sets a catalogue of conditions and factual predicates which are to be applied by decision-makers resolving claims under the VEA or MRCA scheme (s 4, s 7). It does not itself create benefit entitlements; rather it operates as an evidentiary filter and a medical‑scientific statement for claim determinations under the cited Acts.

Primary persons affected

• Claimants: the instrument applies to claims under the VEA or MRCA framework, specifically to claims to which section 120B of the VEA or section 339 of the MRCA applies (s 4). Practically, persons who have diaphragmatic hernia or who have died from a terminal event contributed to by diaphragmatic hernia will be affected when seeking a service connection under those claim provisions.

• Deceased persons’ estates or dependants: the inclusion of “death from diaphragmatic hernia” (s 6(3)) means that death-benefit or service-connection assessments for persons whose terminal event was contributed to by diaphragmatic hernia fall within the instrument’s scope.

Decision-makers and administrative actors

• The Repatriation Medical Authority (RMA) is the issuer of the Statement (s 3). The RMA expresses the medical‑scientific view that gives the Statement force (s 7). The Statement is intended to be applied in the claim resolution processes under the VEA and MRCA; those decision-makers will use the Statement’s factors when assessing service connection. The instrument itself does not name the claim decision-makers, but its application (s 4) ties it to the respective claim procedures in the VEA and MRCA.

Service organisations and medical practitioners

• Public and private medical practitioners who prepare clinical records, operative reports, imaging, trauma reports, and obstetric records will be relevant sources of evidence for establishing the factors listed in section 8. The Statement identifies particular surgical procedures and trauma mechanisms by way of example (s 8 notes), and those clinical records will be material in proving the temporal and anatomical links required.

Who bears the evidential task

• The Statement sets the factual predicates that “must exist” for a finding on the balance of probabilities (s 8). While the Statement does not itself allocate procedural burdens, its operation in claims requires that claimants adduce evidence to show one or more of the listed factors and that the factor(s) are related to their relevant service (s 9(1)). Where a claimed factor connects to an injury or disease covered by another Statement, evidence will also need to satisfy the tests contained in that other Statement (s 10).

Categories of service that qualify as “relevant service”

• The Schedule defines “relevant service” narrowly: eligible war service (other than operational service) under the VEA; defence service (other than hazardous service and British nuclear test defence service) under the VEA; and peacetime service under the MRCA (Schedule 1, relevant service). Persons whose service does not fall into these statutory categories will not be within the instrument’s defined ambit.

Secondary effects and third parties

• Hospitals, surgeons, employers (for trauma documentation), and defence administrative record-holders will also be affected insofar as they hold records required to prove the presence and timing of the factors listed in s 8. The instrument’s factors may also interact with other Statements of Principles for injuries or diseases referenced in s 8, potentially implicating other administrative determinations (s 10).

This Statement of Principles sets out factual criteria and qualifications to be applied in claims; it does not itself create statutory duties or criminal penalties. Nonetheless it produces operational duties and evidential rights within the claims process because it prescribes which factors, if established and related to relevant service, suffice to satisfy the RMA’s balance‑of‑probabilities view.

Key operational duties (derived from the instrument)

• Duty to show a qualifying factor: A claim that relies on the Statement must establish that at least one of the factors in section 8 exists. The language is mandatory: “At least one of the following factors must exist before it can be said that, on the balance of probabilities, diaphragmatic hernia or death from diaphragmatic hernia is connected with the circumstances of a person's relevant service” (s 8). That creates an evidentiary duty on claimants to produce material that establishes one or more listed factors.

• Duty to relate the factor to relevant service: Section 9(1) requires that the existence of any factor in s 8 be related to the person’s relevant service. The practical implication is that evidence must not only show the clinical event or circumstance listed in s 8, but that event or circumstance must have a demonstrable connection to the service category defined in the Schedule. The instrument does not spell out the precise standard for how relationship to service is to be proved beyond this requirement, but it makes the relationship a necessary predicate.

• Temporal and causal qualification duties: The instrument imposes temporal limits and causal qualifiers on several factors. For example, the surgical procedure factor requires the procedure to have occurred within ten years before the clinical onset of diaphragmatic hernia (s 8(1)), and an analogous ten‑year reference applies for clinical worsening (s 8(4)). The pregnancy factor is limited to being pregnant within six weeks before the clinical worsening (s 8(7)). It follows that claimants need to establish dates and sequenced clinical events.

• Special duty where pre-existing hernia is present: Section 9(2) constrains the operation of subsections 8(4)-(8): they apply only to material contribution to, or aggravation of, diaphragmatic hernia where the person’s diaphragmatic hernia was suffered or contracted before or during (but did not arise out of) the person’s relevant service. This creates a particular evidentiary pathway for claims alleging aggravation of pre-existing diaphragmatic hernia.

Rights and protections created or recognised by the instrument

• Right to have death considered if contributed to by the condition: The Statement expressly includes death from diaphragmatic hernia where the hernia contributed to the terminal event or condition (s 6(3)), thus extending the Statement’s applicability to mortality cases where a contribution is alleged. The Schedule enumerates example terminal events.

• Right to rely on related Statements: Where an s 8 factor is an injury or disease already covered by another Statement of Principles, the claimant can rely on the factors in that other Statement “in accordance with the terms of that Statement as in force from time to time” (s 10). This provides a mechanism to utilise the RMA’s determinations for related conditions.

• Evidentiary predictability: The instrument gives claimants and decision-makers a predetermined list of qualifying factors accepted by the RMA as, on available evidence, capable of establishing service connection on the balance of probabilities (s 7 and s 8). That list functions as a guide to the evidence claimants should prioritise.

Limitations and duties not created

• No new statutory duty on third parties: The Statement itself does not compel hospitals, practitioners, or government departments to produce records. It identifies the types of clinical or traumatic events that must be shown for service connection, but the practical acquisition of records occurs under the normal evidentiary and administrative processes of claim resolution.

• No criminal or administrative penalties in the instrument: The instrument contains no penalty provisions or enforcement powers; it is a medical‑scientific determination to be applied within the claim frameworks specified (s 3, s 4). Any sanctions or procedural consequences would come from the governing VEA or MRCA provisions and administrative processes, not from the Statement itself.

The instrument contains no penalty provisions and does not itself establish enforcement mechanisms. It is a determinative Statement of Principles, made under subsection 196B(3) of the VEA, intended to be applied in the adjudication of claims under the VEA or the MRCA (s 3; s 4). The RMA’s role in this instrument is to articulate, on available medical‑scientific evidence, the factors that are sufficient to establish a connection on the balance of probabilities between diaphragmatic hernia (or death from it) and relevant service (s 7).

Practical enforcement context

• Application in claims procedures: The instrument takes effect through its application to claims governed by section 120B of the VEA or section 339 of the MRCA (s 4). Enforcement in practical terms occurs via administrative decision-making under those Acts, where decision-makers will apply the Statement’s factors to decide service connection. The Statement does not itself create investigatory or sanctioning powers; it is an evidentiary instrument.

• No sanctions or penalty clauses: Nowhere in the instrument are criminal, civil or administrative penalties specified for non‑compliance or misstatement of facts. Any inquiry into fraudulent claims, misrepresented medical history, or other offences would fall under the enforcement provisions of the VEA, the MRCA or other applicable laws, not this Statement. The Statement is silent on such processes.

Evidentiary effect and implications

• The Statement has evidentiary force as the RMA’s view of medical‑scientific evidence: Section 7 records the RMA’s view that on the balance of probabilities the condition can be related to relevant service. That view will be relied upon by claim decision-makers to accept particular causal pathways without the need for novel medical opinion where the listed factor(s) are established and related to service. The Statement therefore functions as a tool that can simplify the factual inquiry in adjudication, but it does not itself enforce or compel performance.

Limits of administrative discretion

• Decision-makers retain the administrative role of applying the Statement in the statutory claim framework; the instrument does not specify how decision-makers must weigh alternative non-listed causal explanations, nor does it preclude further medical enquiry. The instrument constrains service connection by listing qualifying factors and exclusions; enforcement of those constraints is effectively achieved by administrative application during claim assessment rather than by sanctioning mechanisms in the instrument.

Record-keeping and proofs

• Because the Statement requires particular factors and timing to be established (for example, surgery within ten years before clinical onset (s 8(1))), enforcement of the Statement’s effect rests on the practical availability of clinical, surgical and service records and on administrative procedures for producing and evaluating that evidence. The instrument does not itself mandate record production processes.

The Statement is expressly positioned to operate within the statutory frameworks of the VEA and the MRCA, and to interact with other Statements of Principles made under the same statutory mechanism. Its operation is therefore integrative; its interaction with other laws is governed by what the instrument itself says.

Application to claims under VEA and MRCA

• Section 4 states the instrument “applies to a claim to which section 120B of the VEA or section 339 of the MRCA applies.” The instrument thus functions as an evidentiary and determinative input for claims adjudicated under the particular provisions of those Acts. The text does not restate or reframe the substantive provisions of s 120B or s 339, but it binds to those claim processes by reference.

Incorporation and cross-reference to other Statements of Principles

• Section 10 prescribes how the instrument interacts with other Statements: where an s 8 factor refers to an injury or disease already covered by another Statement of Principles made under subsection 196B(3) of the VEA, then the factors in that other Statement apply according to its terms “as in force from time to time” (s 10). This creates an explicit cross-reference mechanism whereby the applicable tests for the referred injury or disease remain those set out in the relevant Statement rather than being re-specified here. The effect is that the RMA’s network of Statements can be read together, with each Statement retaining its own operative terms.

Definitions tie the instrument to statutory categories

• The Schedule defines “relevant service”, “MRCA” and “VEA” (Schedule 1). By using those statutory terms the instrument constrains its reach to the legal categories already established in those Acts. Thus the interaction with other laws is mediated by the statutory categories: whether a person’s service qualifies as “relevant service” is determined by the statutory definitions in the VEA and MRCA frameworks, and only those categories are within the instrument’s purview.

No inconsistency provision in the instrument

• The instrument does not purport to override other statutes or to displace other determinations. It does not contain an express provision to the effect that it prevails over inconsistent administrative policy or other Statements. Instead, the instrument is structured as one input to statutory claim processes and provides a set of qualifying factors whose establishment will support a finding of service connection as contemplated by the VEA or MRCA.

Dynamic operation with other instruments

• Section 10’s reference to other Statements “as in force from time to time” means this Statement’s operation can change in practice as other Statements are amended, replaced or revoked. That produces an interaction in which the legal regime for service connection is a composite of current Statements rather than a static single-authority instrument.

Absence of cross-border or extraneous law references

• The Statement does not reference or incorporate other Commonwealth statutes beyond the VEA and MRCA definitions used in the Schedule, nor does it make reference to State or Territory laws. Its legal interactions are therefore primarily internal to the RMA’s Statement network and the VEA/MRCA claim frameworks.

This instrument is presented as Statement of Principles concerning diaphragmatic hernia (Balance of Probabilities) (No. 100 of 2022). The document records the following key dates and formal particulars:

• Date of determination: the instrument is dated 21 October 2022 (cover page and signature block).
• Commencement: the instrument commences on 21 November 2022 (s 2).
• Authority: it is made under subsection 196B(3) of the Veterans' Entitlements Act 1986 (s 3).
• Instrument number and identification: titled as No. 100 of 2022 and described on the face of the Statement.

The instrument as supplied contains no internal amendments, schedules of amendment history, or notation of prior versions. It contains no textual footnote indicating earlier Statements for diaphragmatic hernia. The text records the operative date and signature of the RMA chairperson, but does not include a schedule of prior determinations or later amending instruments.

Practical consequences for amendment tracking

• Because s 10 refers to other Statements “as in force from time to time”, practitioners should note the instrument is intended to be read alongside the current universe of RMA Statements, which are subject to amendment. The instrument itself does not list or stipulate a mechanism for amendment beyond the normal statutory power under which it was made (subsection 196B(3) of the VEA). Any future amendment to this Statement would, in consequence, be shown in its replacement instrument or amending instrument as published under the same statutory scheme.

What the instrument does not say about amendment

• The instrument does not include transitional provisions, savings clauses, or retrospective modification language. It therefore operates from its stated commencement date. The text does not identify any previous Statements superseded or revoked by it.

Where to look for updates

• The authoritative record of any subsequent amendment or replacement would be the RMA’s published instruments under subsection 196B(3) of the VEA. This Statement’s cross-references to other Statements (s 10) mean that practitioners who rely on it should monitor the RMA’s other Statements for changes that could affect the application of factors referenced here.

The instrument itself contains no statement of litigation history. There are no cases, proceedings, or judicial determinations referenced or incorporated in the text. The Statement does not list any decisions that have interpreted it, nor does it include references to administrative review outcomes, appeals, or judicial reviews.

Practical implication

• Because the Statement is a medical‑scientific determination made under subsection 196B(3) of the VEA and because no litigation is recorded in the instrument, there is no textual basis within this document to analyse or cite case law concerning its interpretation or application. Any judicial or administrative interpretation of this Statement, or of the application of its factors in adjudicating claims under the VEA or MRCA, would exist outside the instrument and is not presented here.

What is not present

• The Statement does not identify contested interpretations of terms such as “clinical onset”, “clinical worsening”, “affected region of the diaphragm” or the threshold of “inability to obtain appropriate clinical management”. It likewise does not mention any past decisions which might have shaped the RMA’s view. The instrument therefore presents the RMA’s settled factors without accompanying litigation context.

How practitioners should proceed

• Given the absence of litigation history in the instrument, practitioners who wish to know whether, and how, tribunals or courts have applied this Statement will need to consult administrative tribunal decisions and court decisions external to the instrument. The instrument itself provides the RMA’s current standards as of its commencement date, but not judicial construction of those standards.

This Statement of Principles contains several practical pitfalls and interpretive traps that arise from its structure, the specific qualifications it imposes, and the terminology it uses. The points below identify those features as direct consequences of the text.

Exclusions that are decisive

• The instrument excludes congenital diaphragmatic hernia, eventration of the diaphragm and hiatus hernia from the definition of diaphragmatic hernia (s 6(2)(b)(i)-(iii)). A claimant with one of those diagnostic labels cannot rely on this Statement to establish service connection for that condition. Practitioners must ensure the clinical diagnosis is for an acquired diaphragmatic hernia as defined in s 6(2)(a).

Surgical exclusion of oesophageal hiatus

• The surgical factors in s 8(1) and s 8(4) require the procedure to involve the affected region of the diaphragm “excluding the oesophageal hiatus.” Claims based on surgery that exclusively involved the oesophageal hiatus (for example, some procedures for hiatus hernia or antireflux surgery) will not satisfy those surgical factors. The exclusion is explicit in the text (s 8(1), s 8(4)).

Temporal windows are strict and asymmetrical

• The ten‑year window for surgical procedures (s 8(1) and s 8(4)) is a fixed temporal rule. Similarly, pregnancy is limited to being within six weeks before clinical worsening (s 8(7)). These are precise temporal thresholds in the instrument and will require documentary proof of dates. Failure to demonstrate the relevant dates may preclude reliance on the associated factor.

Ambiguity of “clinical onset” and “clinical worsening”

• The instrument uses the terms “clinical onset” and “clinical worsening” as anchors for several factors but does not define them within the text. That absence creates interpretive work for clinicians and decision-makers when identifying the relevant date for the ten‑year period or the six‑week period. Practitioners should anticipate disputes about when symptoms or deterioration reached the threshold of “clinical” onset or worsening, and will need to rely on contemporaneous clinical records to substantiate their position.

Requirement that the factor be related to relevant service

• Section 9(1) states that any factor referred to in s 8 must be related to the person’s relevant service. Establishing a factor alone is not sufficient; there must be a link between the factor (for example, an operation or traumatic event) and the person’s relevant service. The instrument does not supply a formula for that relationship, leaving it to the claim process to establish the causal connection between the factor and service.

Complexity where pre-existing hernia exists

• Section 9(2) confines subsections 8(4)-(8) to material contribution to, or aggravation of, diaphragmatic hernia where the hernia was suffered or contracted before or during (but did not arise out of) the person’s relevant service. This produces a layered test: the claimant must show (a) that the hernia existed before or during service but did not arise out of it; and (b) that one of the listed factors materially contributed to or aggravated the condition. That ordering can be counterintuitive and requires careful evidence of the timing of the original hernia and subsequent worsening events.

“Inability to obtain appropriate clinical management” is a non‑specific factor

• Section 8(8) lists “inability to obtain appropriate clinical management for diaphragmatic hernia” as a qualifying factor. The phrase is open-ended and is not exhaustively delimited in the instrument. Practical proof will likely require evidence of attempted access to care, referrals, logistical barriers or systemic failures. The Statement provides no checklist for what will satisfy this factor, which may lead to disputes about the standard of proof required to establish inability to obtain appropriate management.

Cross-reference to other Statements can shift applicable tests

• If an s 8 factor refers to an injury or disease that is separately covered by another Statement, s 10 requires the factors in that other Statement to apply “as in force from time to time.” This means that reliance on an s 8 factor might require satisfying additional or different tests than those set out here. Practitioners must check the current content of any such referenced Statement to understand the full evidentiary requirements.

Scope of “affected region of the diaphragm”

• Several factors require that the event involve the “affected region of the diaphragm.” The instrument does not provide an anatomical map or further explanation of that phrase, which may generate dispute as to whether a particular surgery, trauma or endometriosis localisation is sufficiently implicated.

“Relevant service” is narrowly defined

• The Schedule’s definition of “relevant service” excludes certain categories (for example, operational service is excluded from the listed categories for eligible war service). Practitioners must confirm that a claimant’s service falls within the Schedule’s definition; otherwise the Statement will not apply (Schedule 1, relevant service).

No penalties or enforcement mechanisms within the instrument

• Because the Statement contains no enforcement or penalty provisions, judicial or tribunal outcomes will derive from the application of this Statement within the VEA/MRCA frameworks rather than from the Statement itself. Practitioners should be aware that the Statement is a medical‑evidentiary tool rather than a stand-alone source of rights or sanctions.

Compliance in this context means assembling and presenting the evidence necessary for a decision-maker adjudicating a claim under the VEA or MRCA to find, on the balance of probabilities, that diaphragmatic hernia or death from diaphragmatic hernia is connected with relevant service in accordance with this Statement. The instrument specifies the qualifying factors and the temporal and relational constraints which guide the required evidence. The following steps mirror the instrument’s structure and cite the relevant sections.

1. Confirm condition and exclusions

• Establish that the diagnosed condition fits the instrument’s definition: an acquired protrusion of intra‑abdominal tissue through the diaphragm into the thoracic cavity (s 6(2)(a)). Exclude congenital diaphragmatic hernia, eventration of the diaphragm and hiatus hernia, because they are expressly excluded (s 6(2)(b)(i)-(iii)).
• For death claims, obtain cause-of-death and terminal-event documentation showing the diaphragm condition contributed to the terminal event(s) listed or comparable terminal causes (s 6(3); Schedule 1, terminal event examples).

2. Identify which s 8 factor(s) the claim relies on

• The Statement requires at least one qualifying factor from s 8. Carefully select the factor(s) that fit the claimant’s clinical and service history:
  • Surgical procedure involving the affected region of the diaphragm, excluding the oesophageal hiatus, within ten years before clinical onset (s 8(1)).
  • Acute trauma to the affected region before clinical onset (s 8(2)).
  • Endometriosis involving the affected diaphragmatic region before clinical onset (s 8(3)).
  • Analogous factors tied to clinical worsening (s 8(4)-(6)).
  • Pregnancy within six weeks before clinical worsening (s 8(7)).
  • Inability to obtain appropriate clinical management (s 8(8)).

3. Assemble clinical and procedural proof for the chosen factor(s)

• For surgical factors (s 8(1), s 8(4)):

  • Obtain operative reports, surgical notes, theatre lists, histopathology, imaging reports, and discharge summaries showing the procedure involved the affected region of the diaphragm and the date of operation.
  • Demonstrate that the operation was not limited to the oesophageal hiatus if that is a point of contention, since the instrument excludes the oesophageal hiatus.
  • Check the ten‑year lookback period relative to the clinically ascertainable date of “clinical onset” or “clinical worsening”; assemble evidence to define those dates from clinical notes, imaging reports or specialist statements.

• For trauma factors (s 8(2), s 8(5)):

  • Collect emergency department records, ambulance reports, police reports, imaging (CT/chest X-ray), surgical or procedural notes relating to the trauma.
  • Establish the anatomical location of the trauma and timing relative to clinical onset/worsening.

• For endometriosis (s 8(3), s 8(6)):

  • Collate gynaecological reports, operative findings, histology confirming diaphragmatic or pelvic endometriosis, and imaging showing localisation to the affected diaphragmatic region.

• For the pregnancy factor (s 8(7)):

  • Provide obstetric records, antenatal notes and delivery/complication summaries evidencing pregnancy within six weeks before documented clinical worsening.

• For “inability to obtain appropriate clinical management” (s 8(8)):

  • Produce correspondence, referrals, waiting-list evidence, clinic appointment attempts, telehealth records or administrative records demonstrating unsuccessful attempts to obtain treatment or specialist review.
  • If asserting system-level impediments, assemble contemporaneous evidence of the nature, duration and effect of the lack of access.

4. Establish dates of “clinical onset” and/or “clinical worsening”

• Because several qualifying factors are anchored to “clinical onset” or “clinical worsening”, extract and document the earliest clinical records indicating the manifestation of symptoms, diagnostic imaging reporting, hospital admission notes or specialist assessments that mark those events. Where the clinical record is ambiguous, seek a contemporaneous specialist statement to articulate why a particular date represents clinical onset or worsening.

5. Link the factor(s) to relevant service

• Section 9(1) requires that the factor be related to the person’s relevant service. To comply, obtain and lodge service records, unit histories, incident reports or other defence documentation that demonstrate how the surgical procedure, trauma, pregnancy, inability to obtain care or endometriosis is related to the claimant’s qualifying service period as defined in the Schedule.
• Confirm the claimant’s service falls within the Schedule’s “relevant service” categories: eligible war service (other than operational service), defence service (other than hazardous service and British nuclear test defence service) under the VEA, or peacetime service under the MRCA (Schedule 1, relevant service). If service status is unclear, secure official service history records.

6. Special pathway for pre-existing diaphragmatic hernia

• If the claimant’s diaphragmatic hernia was suffered or contracted before or during relevant service but did not arise out of service, and the claim alleges material contribution or aggravation, then only s 8(4)-(8) apply (s 9(2)). Compliance here requires:
  • Evidence that the hernia pre-existed or existed during service but did not arise out of service.
  • Evidence that one of the s 8(4)-(8) factors materially contributed to or aggravated the hernia (medical opinion, imaging showing progression, clinical records of deterioration temporally linked to the factor).

7. Check for references to other Statements and satisfy those tests

• If an s 8 factor refers to an injury or disease covered by another Statement, s 10 requires that the factors in that other Statement apply as in force from time to time. Identify any such cross-references and compile evidence required by the referenced Statement in addition to the evidence required under this Statement.

8. Prepare medico-legal synthesis

• Where clinical records alone may not resolve causal linkage or the timing of “clinical onset/worsening”, obtain a specialist medico-legal or clinical opinion that:
  • Applies the defined terms and temporal windows set out in the Statement.
  • Gives an opinion on whether, on the balance of probabilities, the factor(s) present meet the RMA’s criteria for service connection and how they relate to the claimant’s relevant service.

9. Document chain of proof and present in claim

• In claim submissions, identify which s 8 factor(s) are relied upon, cite the pertinent dates and clinical documents, set out how the factor is related to relevant service (s 9(1)), and where applicable, show that the claim satisfies the s 9(2) material contribution/aggravation pathway.
• Provide the primary clinical documents as annexures and include a concise chronology tying events, clinical findings, interventions and service history to the legal thresholds in the Statement.

10. Anticipate interpretive disputes

• Be prepared to address contested dates for onset/worsening and to justify why a particular surgical procedure involved the “affected region” and not only the oesophageal hiatus. For assertions about inability to obtain management, anticipate requests for specific contemporaneous evidence of attempts to access care and any administrative barriers encountered.

Following the procedure outlined above aligns evidentiary assembly and presentation with the Statement’s precise textual requirements (s 6, s 7, s 8, s 9 and s 10, and Schedule 1). The Statement’s mandatory phrasing , “must exist” (s 8) and the relational requirement (s 9) , means decision-makers will look for a direct fit between the evidence and the enumerated factors; assembling direct, contemporaneous clinical and service records in conformity with the textual thresholds will therefore be the most effective compliance strategy.