Statement of Principles concerning discoid lupus erythematosus (Reasonable Hypothesis) (No. 49 of 2025)

The central concept is the “reasonable hypothesis” that must connect DLE to relevant service. The instrument itself does not define that term, but it derives from the VEA and the MRCA. The SoP supplies the content by listing the factors that must exist for that hypothesis to be raised. The definition of DLE is critical: it means a form of chronic cutaneous lupus erythematosus that commonly presents with erythematous, scaly plaques that often heal with scarring and atrophy, with a preference for the concha of the ear, head or neck. That definition excludes acute cutaneous lupus erythematosus, chilblain lupus erythematosus, lupus erythematosus‑lichen planus overlap syndrome, lupus erythematosus panniculitis, lupus erythematosus profundus, lupus erythematosus tumidus, subacute cutaneous lupus erythematosus, and systemic lupus erythematosus. The ICD‑10‑AM code L93.0 is referenced, but the meaning in the instrument prevails over the code. Death from DLE is defined to include death from a terminal event that was contributed to by the person’s DLE. “Terminal event” is defined as the proximate or ultimate cause of death, including pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function. The concept of “clinical onset” and “clinical worsening” are used throughout, but are not defined in the instrument; they will be interpreted in practice by the Repatriation Medical Authority and decision‑makers. The factor for smoking requires at least 10 pack‑years before clinical onset or worsening, provided smoking has not ceased before that time. “One pack‑year” is defined as the amount of tobacco consumed in smoking 20 cigarettes per day for one year, or an equivalent amount of tobacco products, with note that 7,300 grams of smoking tobacco by weight is equivalent. The method for calculating pack‑years is set out: number of cigarettes per day divided by 20, multiplied by number of years smoked. The factor for sunlight requires exposure at a level sufficient to induce erythema (sunburn) at least 24 hours but not more than 30 days before clinical onset or clinical worsening. That is a relatively narrow temporal window. The medications factor is in two parts: a listed group of specific drugs (with exclusions such as topical fluorouracils) and a broader category of any medication associated with DLE that shows improvement within three months of discontinuation, provided therapy continued for at least three days before clinical onset or worsening. The factor for PTSD requires that the condition existed for at least three months before clinical onset or worsening. The factor for estradiol menopausal hormone therapy requires use for at least two years before clinical onset. The concept of “inability to obtain appropriate clinical management” only applies to clinical worsening, not onset. The dictionary also defines “relevant service” by reference to various categories of military service under the VEA and MRCA. Finally, section 11 creates a cross‑reference mechanism such that if a factor (such as PTSD) refers to a disease covered by another SoP, the factors from that other SoP apply. This means that anyone relying on the PTSD factor must also satisfy the requirements of the SoP for PTSD, as in force from time to time.

The primary group affected is veterans and members who have rendered “relevant service” as defined in the instrument. That includes any person who has operational service, peacekeeping service, hazardous service or British nuclear test defence service under the VEA, or warlike or non‑warlike service under the MRCA. The instrument also affects the dependants of such persons who claim in relation to the death of a veteran or member, because the definition of death from DLE extends to death contributed to by DLE. The instrument therefore shapes the eligibility of thousands of claimants seeking compensation or treatment for DLE. It also directly affects medical practitioners who are asked to provide evidence in support of a claim, because they must be aware of the specific factors and definitions. For example, a dermatologist diagnosing DLE must ensure the diagnosis fits the narrow definition excluding other forms of lupus, or the claim may fail on a preliminary point. The instrument imposes obligations on the Department of Veterans’ Affairs and the Military Rehabilitation and Compensation Commission to apply these factors when assessing claims. It binds decision‑makers at the primary level and on review before the Veterans’ Review Board and the Administrative Appeals Tribunal. The Repatriation Medical Authority itself is affected as the body that made the determination and may be required to explain its reasons if the instrument is challenged. Industry participants such as pharmaceutical companies whose drugs are listed (fluorouracils, immune checkpoint inhibitors, leflunomide, palbociclib, secukinumab, TNF‑alpha inhibitors) are indirectly affected because the causal link to DLE is now formally recognised. That may influence prescribing patterns and clinical documentation. The instrument also affects providers of menopausal hormone therapy; a veteran who has used estradiol for at least two years before DLE onset may have a claim pathway even if the therapy occurred in civilian life, provided the therapy is related to service (which may be difficult if the hormone therapy was unrelated). The smoking factor potentially affects a large proportion of the veteran population, as smoking rates have historically been higher among serving members. The PTSD factor may have significant implications given the prevalence of PTSD in veteran cohorts. Finally, the instrument affects the legal and advocacy profession, including lawyers, claims officers and volunteer advocates who must understand the technical provisions, especially the cross‑reference to other SoPs and the distinction between clinical onset and clinical worsening.

The instrument itself does not create duties in the traditional sense, but it confers rights indirectly by specifying the conditions under which a claim can succeed. The central right is the right of a claimant to have a reasonable hypothesis accepted if they can establish at least one factor and the factor is related to their relevant service. That right is not absolute; it depends on the existence of the factor and the relationship to service. The instrument also gives the decision‑maker a duty to apply these factors when determining whether a reasonable hypothesis is raised. Under section 9, the decision‑maker must be satisfied that at least one factor exists before concluding that the hypothesis is raised. That is a mandatory condition. The decision‑maker also has a duty to consider the cross‑reference under section 11 if a factor refers to another disease covered by another SoP. For example, if a veteran relies on the PTSD factor, the decision‑maker must apply the SoP for PTSD, as in force from time to time, including its own factors and definitions. That creates a cascading obligation. The veteran has the right to present evidence on any factor, but also bears the burden of proving the factor exists and that it is related to service. There is no right to choose which factor to rely on; at least one must be established. Where clinical worsening is claimed, the instrument imposes an additional duty on the decision‑maker to determine whether the worsening was contributed to by a factor and whether the DLE was suffered or contracted before or during (but did not arise out of) the relevant service. This ensures that claims for aggravation are not used to circumvent the requirement that the onset must be linked to service. The factor regarding inability to obtain appropriate clinical management for DLE before clinical worsening implies a right to appropriate management, but that is not a positive duty on the state; rather, the absence of management can be a factor for compensation. The definition of death from DLE includes a right to claim where DLE contributed to a terminal event, even if DLE was not the direct cause. This broadens the scope of death‑related claims. The instrument also gives the Repatriation Medical Authority the right to determine the factors, but that is a power, not a duty, conferred by the VEA. In summary, the instrument structures the rights and duties of claimants and decision‑makers within the existing statutory framework, adding specificity to the reasonable hypothesis test.

The Statement of Principles itself imposes no penalties. It is a legislative instrument that sets out evidentiary criteria; it does not create offences or civil penalties. Enforcement of the rules surrounding claims for DLE operates through the administrative review and appeal process. If a claim is incorrectly rejected or accepted due to misapplication of the SoP, the remedy lies in internal review by the Department of Veterans’ Affairs, merit review by the Veterans’ Review Board, and merits review by the Administrative Appeals Tribunal. Judicial review under the Administrative Decisions (Judicial Review) Act 1977 or section 39B of the Judiciary Act 1903 is also available on limited grounds such as jurisdictional error or breach of natural justice. The VEA itself contains provisions about false or misleading statements (sections 220 and following), but those penalties are not created by this SoP. The primary enforcement mechanism is the requirement that the claim decision must be consistent with the SoP. If a decision‑maker fails to apply the SoP correctly, that decision is liable to be set aside on review. The instrument is binding on the decision‑maker through the statutory framework: section 120A of the VEA and section 338 of the MRCA require that the reasonable hypothesis test be determined in accordance with the prevailing SoP. Failure to do so is an error of law. The Repatriation Medical Authority’s determination is itself subject to limited merits review? No, the RMA’s decisions are not directly reviewable on the merits; they are legislative in character. However, a court could potentially find that the SoP is invalid if it failed to meet the statutory requirement that it be based on “sound medical‑scientific evidence”. That would be a rare challenge. In practice, enforcement is driven by claimants and their representatives who point out discrepancies between the decision and the SoP. There are no monetary penalties for failing to comply with the SoP as such. Instead, the consequence is that the claim may succeed or fail depending on the correct application. For claimants, the “penalty” of non‑compliance is loss of compensation or treatment. There is no right to damages for misapplication other than through the review process. The instrument therefore relies on the integrity of the administrative system and the threat of appeal to ensure correct application.

This instrument is made under subsection 196B(2) of the Veterans’ Entitlements Act 1986, and it operates within that Act’s framework. Specifically, it gives content to the reasonable hypothesis test in section 120A of the VEA and section 338 of the Military Rehabilitation and Compensation Act 2004. When a claim is made under those provisions, the decision‑maker must apply this SoP. The instrument explicitly states that it applies to claims under both Acts, so it bridges the two compensation schemes. It also interacts with the general law of veterans’ entitlements, including the standard of proof provisions (reasonable satisfaction for operational service in s 120(1) and reasonable hypothesis in s 120A). The instrument contains a cross‑reference provision (section 11) that links it to other Statements of Principles. If a factor in section 9 refers to a disease (such as post‑traumatic stress disorder) that is itself the subject of a SoP, then the factors from that other SoP apply. This means that a claim based on PTSD as a factor for DLE will require not only that the PTSD factor in this SoP is met, but also that the reasonable hypothesis for the PTSD itself is raised under its own SoP. That creates a chain of causation that must be followed. The instrument also interacts with the Interpretation Act 1901 (Cth) for principles of statutory construction. It also references the ICD‑10‑AM code L93.0, which is a clinical coding system used in hospitals, but the instrument makes clear that its own definition prevails. That means that administrative decisions about clinical coding are subordinate to the instrument’s definition. The instrument repeals the previous SoP on DLE (No. 126 of 2015), so it supersedes any earlier binding authority. However, the previous SoP may still be relevant for claims lodged before 19 May 2025, depending on transitional provisions in the VEA. The instrument does not address transitional matters, so those are determined by the general law of the VEA. It also interacts with the defence service pensions and veterans’ medical treatment arrangements, though indirectly: if a DLE claim is accepted, the veteran may become eligible for treatment and pension under the VEA or the MRCA. The instrument does not create those entitlements; it only establishes the causal link. Finally, it interacts with state workers’ compensation schemes only to the extent that a claim under a state law might rely on a reasonable hypothesis for a different purpose, but this SoP is specifically for the VEA and MRCA and would not bind state decision‑makers.

The instrument is a new Statement of Principles that replaces the previous one, No. 126 of 2015, which was made under the same subsection 196B(2). The former SoP is repealed on commencement of this instrument (19 May 2025). There is no indication in the source of any intermediate amendments between 2015 and 2025. The instrument itself is the first version of this particular determination. The change in number from 126 of 2015 to 49 of 2025 suggests a periodic review by the Repatriation Medical Authority. The RMA is required under section 196B of the VEA to determine SoPs based on sound medical‑scientific evidence, and it may revoke or vary them. Therefore, this instrument represents the current state of medical evidence as assessed by the RMA as at April 2025. The preamble states that the RMA is of the view that there is sound medical‑scientific evidence indicating that DLE can be related to relevant service. That view is the basis for the instrument. The repeal of the 2015 SoP indicates that the RMA considers the earlier determination no longer reflects the current evidence base or that changes in definitions or factors were necessary. No reasons are given in the instrument itself. The only formal amendment history for this instrument is that it is the original as made. It may be amended in the future by a subsequent SoP. The instrument does not include any transitional or savings provisions, so its application to claims in progress would be determined by the general law, which typically applies the SoP in force at the time of the decision. This means that a claim that was lodged before 19 May 2025 but decided after that date will be assessed under this new SoP. The previous SoP remains relevant for decisions made before that date. There is no indication of any earlier SoP before 2015, though the RMA has been making SoPs for many years. The instrument therefore stands as the current and only operative SoP for DLE from its commencement date.

The instrument itself is a new legislative instrument and has not been the subject of any litigation because it had not yet commenced as at the date of the source (April 2025). No court or tribunal decisions are referenced within the instrument. The previous SoP (No. 126 of 2015) may have been considered in decisions of the Administrative Appeals Tribunal or the Federal Court, but the source does not mention any such cases. In the broader context of veterans’ law, Statements of Principles from the Repatriation Medical Authority have occasionally been challenged on the ground that the RMA failed to properly assess the medical‑scientific evidence. For example, the High Court in Repatriation Commission v Gooey (1997) and the Full Federal Court in Repatriation Commission v Gosewisch (2017) considered the nature of the reasonable hypothesis test and the role of SoPs, but those cases do not concern this particular instrument. It is possible that future litigation may arise if a claimant or the Commission argues that a factor in this SoP is not based on sound medical‑scientific evidence. A court could potentially declare the instrument invalid in whole or in part if it exceeded the statutory power or failed to meet the legal standard. However, such challenges are rare and difficult to mount. The instrument also provides that the factors must be related to the person’s relevant service. That requirement may be litigated to determine the degree of connection required. For example, must the sunlight exposure have occurred during service, or can it be during leave? The instrument does not specify, so tribunals may develop case law on what “related to” means. Similarly, the factor for smoking requires that smoking has not ceased before clinical onset or worsening; this may lead to disputes over when “cessation” occurred and whether temporary cessation suffices. The exclusion definitions for DLE may also be contested in individual cases, with expert evidence on whether a particular patient’s condition falls within the defined form. In summary, while there is no litigation history for this specific instrument, it is part of a larger body of decisions interpreting statements of principles, and it is likely to generate its own body of tribunal and court decisions over time.

Several aspects of the instrument can catch out unwary claimants and decision‑makers. First, the definition of discoid lupus erythematosus is narrow and excludes eight other forms of lupus. If a veteran has subacute cutaneous lupus erythematosus or lupus panniculitis, the SoP does not apply at all, even if the clinical presentation is similar. The ICD‑10‑AM code is only a reference; the definition in the instrument prevails. A decision‑maker must ensure that the diagnosis matches the precise wording, including preference for the concha of the ear, head or neck. The factor for sunlight exposure requires “erythema (sunburn)” within 24 hours to 30 days before clinical onset or worsening. That is a very specific temporal window. A veteran who suffered chronic sun exposure over years but never a distinct sunburn episode may not satisfy the factor. The exposure must also be at a level sufficient to induce erythema, which may require medical evidence of actual sunburn. The medications factor has traps: the listed drugs exclude topical fluorouracils, so topical use does not qualify. The broader “medication associated with” factor requires that the drug therapy continued for at least three days before onset or worsening, and that within three months of discontinuing the drug, the DLE improved. That imposes a de‑challenge requirement that may be hard to prove retrospectively, especially if the veteran never discontinued the drug. The smoking factor requires that smoking had not ceased before clinical onset or worsening. If the veteran quit smoking even one day before the first symptoms, the factor cannot be used, regardless of the amount smoked. That can be a significant barrier for those who quit before their DLE appeared. The PTSD factor requires the condition to exist for at least three months before onset or worsening. A diagnosis of PTSD made after the onset of DLE will not satisfy this factor unless the PTSD actually predated the DLE by at least three months. The estradiol menopausal hormone therapy factor requires use for at least two years before clinical onset. That excludes shorter term use. The factor concerning inability to obtain appropriate clinical management applies only to clinical worsening, not to initial onset. So if a veteran with DLE cannot get treatment and the DLE worsens, that factor may be available, but it cannot be used to connect the original onset to service. The clinical worsening aspects (section 10(2)) also require that the DLE was suffered or contracted before or during (but did not arise out of) the relevant service. That is a complex condition: if the DLE arose out of service, the worsening factor is not available; only onset factors can be used. The cross‑reference to other SoPs under section 11 means that a claim based on PTSD may require satisfying not only this SoP’s PTSD factor, but also the specific factors in the PTSD SoP. That can create multiple hurdles. The relationship to service requirement (section 10(1)) applies to every factor. Even if a veteran smoked 10 pack‑years, the smoking must be related to their relevant service. A veteran who started smoking after discharge, for reasons wholly unconnected to service, may not meet that requirement. The instrument also does not define “clinical onset”, leaving room for dispute over whether that refers to first symptoms, first diagnosis, or first medical treatment. Finally, the definition of “terminal event” is broad, but it is limited to the listed causes. A death from a cause not listed (e.g., suicide) would not be covered unless DLE contributed to that cause, which would require complex evidence.

For a claimant or their representative, compliance with this SoP means ensuring that the claim is supported by evidence that fits at least one factor. The first step is to obtain a precise diagnosis of DLE that matches the instrument’s definition, including the exclusion of other forms. A dermatologist’s report should explicitly state the type of lupus and, if possible, include comment that the presentation is consistent with chronic cutaneous lupus with predilection for the concha, head or neck. For claims based on sunlight or UV light exposure, the claimant must provide evidence of a sunburn episode within 24 hours to 30 days before the onset or worsening of DLE. Eyewitness accounts, medical records for sunburn, or deployment records showing exposure may be used. The exposure must be related to service: for example, a sunburn suffered during a field exercise or while on operational service in a tropical region. For medications, the claimant must show they were taking one of the listed drugs at the time of onset or worsening, or a drug that satisfies the associated medication test. Pharmacy records, prescription histories and medical charts are essential. For the associated medication test, evidence of improvement after discontinuation is required, which may be difficult if the drug was never stopped. For smoking, the claimant must demonstrate at least 10 pack‑years and that they had not ceased smoking before the clinical onset or worsening. Calculation worksheets may be needed, and the smoking history must be related to service - for example, smoking that commenced or increased during service due to stress or availability. For PTSD, a formal diagnosis by a psychiatrist or psychologist with evidence that the PTSD existed for at least three months before the DLE onset or worsening is necessary, and the PTSD must be related to service. For estradiol therapy, the claimant needs records of at least two years of use before onset, and a link to service (e.g., therapy obtained through a defence health facility). For clinical worsening due to inability to obtain appropriate management, the claimant must show that DLE existed before service or arose independently, and that after service they were unable to access treatment, leading to worsening. That may require evidence of attempts to seek care, wait times, or lack of specialist availability. The decision‑maker must also ensure that the factor is related to service. Therefore, the claimant’s evidence should include a nexus statement explaining how the factor arose from or was connected to their service. For example, a veteran who began smoking during basic training should provide service records or personal statements. The claim must be lodged in accordance with the relevant Act’s time limits. Representatives should also check the cross‑reference to other SoPs: if relying on PTSD, they must ensure the PTSD SoP is satisfied. Finally, when dealing with death claims, the terminal event must be one of the listed causes and must be contributed to by DLE. A death certificate and medical opinion are required. For the decision‑maker, compliance means applying the factors strictly, checking the definitions, and if any factor is established and related to service, finding that a reasonable hypothesis is raised unless contrary evidence displaces it.