Statement of Principles concerning eating disorder (Balance of Probabilities) (No.16 of 2025)

The SOP centres on causation for administrative benefits by specifying medical and exposure criteria that, if established and linked to a claimant’s relevant service, substantiate a connection on the balance of probabilities. Core concepts in the instrument are:

• Eating disorder, defined operationally by DSM‑5‑TR criteria: The SOP reproduces DSM‑derived diagnostic criteria for multiple disorders (anorexia nervosa, bulimia nervosa, binge‑eating disorder, pica, rumination disorder, avoidant/restrictive food intake disorder, other specified feeding or eating disorder, unspecified feeding or eating disorder), as the determinative definition for the SOP (s 7(2)). The SOP also clarifies that although particular ICD‑10‑AM codes are often used for eating disorders, the statutory meaning is the DSM‑derived text (s 7(7)-(8)).

• Clinical onset and clinical worsening: The factors in section 9 are phrased with reference to "clinical onset or clinical worsening" of specific eating disorders. The instrument uses those terms as triggering points for the temporal windows prescribed by each factor (s 9). The SOP does not provide operational definitions for "clinical onset" or "clinical worsening" beyond the DSM criteria that define the disorders themselves, so establishing dates will depend on clinical evidence and adjudicator interpretation.

• Factors and temporal windows: The SOP sets discrete factors, each with an associated time relation to onset/worsening:

  • Category 1A stressor during the 1 year before clinical onset/worsening of several named disorders (s 9(1)).
  • Bullying during the 2 years before clinical onset/worsening of those disorders (s 9(2)).
  • A clinically significant disorder of mental health during the 12 months before onset/worsening of certain eating disorders (s 9(3)). The Schedule clarifies that "clinically significant" only requires that the disorder be sufficiently severe to warrant ongoing management, and that actual treatment need not have been provided (Schedule 1).
  • Childhood serious harm or neglect (under 18) before onset/worsening (s 9(4)).
  • Childhood sexual abuse before onset/worsening of other specified feeding or eating disorder (s 9(5)).
  • Regular food insecurity for a continuous period of 3 months at the time of onset/worsening of binge‑eating disorder (s 9(6)).
  • Type 1 diabetes mellitus for at least 3 months before onset/worsening of anorexia nervosa, bulimia nervosa, or avoidant/restrictive food intake disorder (s 9(7)).
  • Inability to obtain appropriate clinical management for eating disorder before clinical worsening (s 9(8)).

• Relationship to relevant service: A technical constraint is that any factor relied on must be "related to the relevant service rendered" (s 10(1)). The Schedule defines "relevant service" in a way that distinguishes types of service for coverage: eligible war service (other than operational service), defence service (other than hazardous service and British nuclear test defence service), and peacetime service under the MRCA (Schedule 1 relevant service). The SOP also delimits how "clinical worsening" factors operate where the disorder pre‑existed or was contracted before or during service, but did not arise out of service (s 10(2)).

• Interaction with other SOPs: If a factor refers to an injury or disease that is the subject of another SOP made under subsection 196B(3) of the VEA, then that other SOP applies according to its terms as in force from time to time (s 11). That connects this SOP into the broader matrix of RMA determinations.

• Death from eating disorder: The SOP recognises death caused or contributed to by an eating disorder. It explicates that "death from eating disorder" includes deaths from terminal events or conditions contributed to by the person’s eating disorder, and lists proximate causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure, and cessation of brain function in the Schedule (s 7(4); Schedule 1 terminal event).

These concepts produce a structured threshold: a DSM‑level diagnosis, evidence of one or more enumerated factors within prescribed temporal bounds, and a demonstrable link between the factor(s) and the veteran’s relevant service.

Primary affected parties are claimants and decision makers in the VEA and MRCA systems, and stakeholders involved in preparing evidence for claims.

• Claimants: The instrument applies to veterans and members of the Forces who lodge claims under section 120B of the VEA or section 339 of the MRCA (Application: s 5). Those seeking recognition, treatment, rehabilitation or compensation for an eating disorder, or for death from an eating disorder, will be able to rely on the SOP’s factors as the RMA’s determinative medical framework. The Schedule’s definition of "relevant service" narrows eligible service categories to eligible war service (other than operational service), defence service (other than hazardous and British nuclear test defence service), and peacetime MRCA service (Schedule 1 relevant service). Therefore, the SOP’s coverage is limited to claims tied to those service categories; whether a particular veteran’s service falls within those categories will determine whether the SOP is applicable to their claim.

• Decision makers and adjudicators: The SOP is intended to be used by those who determine whether conditions are connected with service under the VEA and MRCA. The instrument itself is made by the RMA under subsection 196B(3) of the VEA (Authority: s 3), and the SOP’s factors and definitions shape the medical causation assessment that decision makers will rely upon when considering claims under the cited provisions (s 5). The SOP therefore affects administrative practice, evidentiary assessment, and clinical expert reliance.

• Medical and allied professionals: Clinicians completing reports for claimants will need to map diagnoses to the DSM‑derived criteria set out in subsection 7(2) and provide opinion on timing of clinical onset or clinical worsening, and whether any of the enumerated factors preceded or materially contributed to the disorder (s 7(2); s 9). Because the SOP uses DSM‑5‑TR text as the diagnostic yardstick and references ICD‑10‑AM codes only as a cross‑reference, clinicians must be explicit about both diagnostic features and timing.

• Administrations and service record holders: Establishing whether a factor is "related to the relevant service" requires documentary or testimonial evidence tying the occurrence or exposure to service circumstances. Entities holding service records, incident reports, and administrative data will be implicated when evidence is assembled to show, for example, bullying, exposure to a category 1A stressor, or inability to obtain clinical management during or as a consequence of service (s 9; s 10).

• Families and estates: For death claims, families and estates will be affected because the SOP recognises death from eating disorder where a terminal event was contributed to by an eating disorder, and lists typical terminal events (s 7(4); Schedule 1).

The SOP also affects the administrative workload, because decision makers will need to consider DSM‑based diagnostic evidence, corroboration of non‑medical factors such as bullying or food insecurity, temporality, and the connection between those factors and relevant service as formally defined (s 9; s 10; Schedule 1).

The SOP itself is a determinative medical statement, rather than an Act that imposes duties or establishes independent rights. Nonetheless, it creates procedural and evidentiary effects within the VEA and MRCA decision framework. The key operative effects and practical duties/rights are as follows:

• Prescriptive evidentiary threshold: The SOP requires that at least one of the enumerated factors exist before an administrative finding that, on the balance of probabilities, eating disorder or death from eating disorder is connected with the circumstances of relevant service (s 9). This operates as a threshold that claimants must meet with evidence, and adjudicators must assess against.

• Right to rely on the SOP: Claimants making a claim under section 120B VEA or section 339 MRCA have the right to rely on this SOP as the Repatriation Medical Authority’s statement of medical causation for eating disorders (s 5). The SOP supplies the RMA’s contemporaneous view of relevant medical‑scientific evidence (s 8). Where a claimant or their medical expert can satisfy the SOP’s factors and link them to relevant service, that forms a core basis for acceptance, subject to the procedural statutes.

• Duty to establish relationship to relevant service: The SOP mandates that any factor must be related to the person’s relevant service (s 10(1)). Practically, claimants have the duty to adduce evidence that connects the factor to their service, and decision makers have the duty to assess that nexus. The Schedule’s definition of relevant service circumscribes which service types the SOP covers (Schedule 1 relevant service).

• Clinical timing duty: The SOP repeatedly hinges on "clinical onset or clinical worsening", with prescribed lookback periods. Claimants have a duty to provide medical evidence that specifies dates or circumscribes onset/worsening sufficiently to fit the temporal criteria (s 9). Medical practitioners have the duty to provide diagnostic and temporal opinion consistent with the DSM‑derived criteria used in the SOP (s 7(2)).

• Interaction with other SOPs: If a factor refers to another injury or disease covered by a different SOP, then that other SOP applies according to its own terms as in force (s 11). Decision makers therefore have a duty to identify and apply linked SOPs where relevant.

• No penal sanctions provided in the document: The SOP does not create new criminal offences or pecuniary penalties. It functions as a medical‑causation instrument to be used within the statutory VEA/MRCA framework, which contains separate statutory obligations and consequences governing entitlements and administrative processes. The instrument itself does not prescribe enforcement mechanisms or sanctions.

• Interpretive duty regarding DSM‑5‑TR and ICD cross‑references: The SOP states that the meaning of eating disorder for the SOP is the DSM‑derived text in subsection 7(2), and that ICD‑10‑AM codes are referenced as coding cross‑references (s 7(7)-(8)). Practitioners and decision makers therefore have an interpretive duty to treat the DSM terms as determinative for the SOP’s medical meaning, and use ICD codes only as coded identifiers.

To locate procedural duties that command how decision makers must apply the SOP (for example, whether application is binding on tribunals or simply influential), one must consult the VEA and MRCA statutory provisions and administrative practice. The SOP itself prescribes the RMA’s medical view and the list of qualifying factors, and requires relationship to relevant service for application (s 8, s 9, s 10).

The Statement of Principles is a medical‑causation instrument and does not itself create criminal offences, civil penalties, or direct enforcement mechanisms. It functions within the administrative framework of the VEA and MRCA. Specific points derived from the instrument:

• No penalties in the SOP text: The instrument contains no provisions imposing fines, imprisonment, administrative penalties, or regulatory sanctions. Its operative content comprises definitions, qualifying factors, and application scope (whole instrument).

• Enforcement via entitlement determinations under VEA/MRCA: The SOP is intended to be used in making determinations about whether a condition is connected with relevant service. Any consequences that follow from that determination, such as eligibility for treatment, rehabilitation, pension, or other benefits, are governed by the VEA or MRCA statutory regimes and their administrative rules. The SOP does not itself specify those entitlements, nor does it specify remedy mechanisms (Application: s 5; Authority: s 3).

• Evidentiary and procedural effect: For decision makers tasked with applying the VEA and MRCA, the SOP provides a predetermined set of medical factors that, if established and tied to relevant service, will support a finding of service connection on the balance of probabilities (s 8, s 9). The effect is to shape administrative outcomes, but the SOP does not prescribe sanctions for non‑compliance with the SOP by any party.

• Administrative discretion and review avenues lie outside the SOP: The SOP does not set out appellate or review procedures. Challenges to determinations that rely on the SOP will be governed by the review rights and processes in the VEA and MRCA and any relevant administrative law remedies, which are not part of this instrument.

• Evidence issues and potential consequences: Although the SOP itself contains no penalties, the requirement that a factor be "related to the relevant service" (s 10(1)), and the temporal windows attached to factors (s 9), mean claimants may be denied entitlements if they cannot meet those thresholds. Those denials may be subject to administrative review, appeals, or judicial review under general administrative law pathways. Such downstream enforcement or contestation mechanisms are available under the enabling statutes rather than the SOP.

In practice, the SOP’s enforcement consequence is therefore indirect: it shapes entitlement decisions under the broader statutory systems, but it imposes no standalone penalties or regulatory enforcement mechanisms.

The SOP is expressly made under subsection 196B(3) of the VEA (Authority: s 3), and it applies to claims under section 120B of the VEA and section 339 of the MRCA (Application: s 5). Its interaction with other legal instruments can be characterised along several dimensions:

• Relationship to VEA and MRCA decision frameworks: The SOP is an RMA determination intended to be used within the decision processes under the VEA and MRCA. It does not create or alter entitlements directly, but provides the RMA’s medical position on causation that decision makers must use where relevant. To understand how binding the SOP is on decision makers and tribunals, one must consult the VEA and MRCA statutory provisions that define the roles of SOPs, which are outside the text of this instrument. The SOP itself references the two statutes as its operative context (s 3, s 5).

• Cross‑reference to other SOPs: Section 11 provides that if a factor in section 9 refers to an injury or disease covered by another SOP, then that other SOP applies according to its terms. This creates a legal network in which multiple SOPs can be invoked and applied in sequence or in combination, subject to their respective terms (s 11). Practically, this requires decision makers to identify linked SOPs and apply their operative tests.

• Diagnostic and classification regimes: The SOP adopts DSM‑5‑TR text as the definitional source for eating disorders (s 7(2); Schedule 1 DSM‑5‑TR). It also notes ICD‑10‑AM codes commonly used for eating disorder conditions, but it instructs that for the SOP’s purposes the DSM‑derived meaning in subsection 7(2) governs (s 7(7)-(8)). Therefore, the SOP instructs application of a United States professional diagnostic manual for statutory causation purposes, while recognising Australian hospital coding as cross‑reference.

• Interaction with civil, criminal, and employment law: The SOP’s definitions of bullying and category 1A stressor incorporate events such as physical assault, sexual molestation, and being held captive (Schedule 1). These events may overlap with matters that are the subject of criminal proceedings, workplace disciplinary processes, or civil claims. The SOP does not change criminal or civil liability, but its findings may coincide with evidence used in those contexts. The SOP does not specify that a criminal conviction is required to establish a category 1A stressor or bullying; it defines bullying and category 1A stressor substantively and relies on evidentiary proof that such events occurred and are related to relevant service (s 9; Schedule 1).

• Medical treatment and administrative health obligations: The SOP includes a factor concerning "inability to obtain appropriate clinical management for eating disorder before clinical worsening" (s 9(8)). That factor may implicate administrative or policy obligations around access to care, but the SOP itself does not create statutory duties on health providers. The determination of whether inability to obtain appropriate clinical management occurred will be evidential and fact specific, and may involve interaction with health policy, service provider availability, and administrative records.

• Death certification and coronial matters: For death claims, the SOP requires that death was from a terminal event or condition that was contributed to by the person’s eating disorder (s 7(4)). That assessment will interact with coronial findings, death certificates, and medico‑legal evidence. The SOP lists proximate causes that count as terminal events in Schedule 1, but it does not change coronial jurisdiction or death‑investigation law.

• No conflict with other legislation is expressed: The instrument contains no provision that purports to override or displace other statutes. Its practical legal effect arises from its statutory source within the VEA regime, and its applicability is limited to claims under the cited sections of the VEA and MRCA (s 5).

In summary, the SOP is an RMA medical statement designed to be used within VEA and MRCA decision processes, to be read alongside other SOPs where factors overlap, and to be operationalised using DSM‑5‑TR diagnostic text and clinical evidence. Its interaction with criminal, civil, employment, and health law is evidential and factual rather than normative or prescriptive in those fields.

The instrument contains a minimal internal amendment history, but it records a specific replacement and a commencement date:

• Repeal of prior SOP: The instrument expressly repeals the Statement of Principles concerning eating disorder (Balance of Probabilities) No. 14 of 2016 (Federal Register of Legislation No. F2016L00264), which was made under subsections 196B(3) and (8) of the VEA (Repeal: s 4). The effect is that SOP No. 14 of 2016 ceases to have effect on and from the commencement of this instrument.

• Commencement: The SOP commences on 28 January 2025 (Commencement: s 2).

• Date of instrument and authorship: The instrument is dated 17 December 2024 and is signed by the Chairperson of the Repatriation Medical Authority (front matter). That date shows the time between signature and commencement, which matters for transition of claims in flight.

• Relationship to other RMA determinations: Section 11 anticipates that other SOPs may be referred to and applied, and it provides that those SOPs apply "as in force from time to time". That phrasing creates an ongoing linkage whereby future amendments to those other SOPs will affect how factors that refer to their covered injuries or diseases are to be treated.

• No other amendments recorded in the instrument: The SOP does not itself record previous amendments beyond the repeal of the 2016 SOP, nor does it list a history of prior iterations. To trace the full evolution of the RMA’s position on eating disorders one must consult previous SOPs and RMA documents external to the present instrument.

For users tracking changes, the critical amendment fact is the explicit repeal of the 2016 SOP and the substitution with this 2025 instrument, effective 28 January 2025. Practitioners must check claim dates, submission timing, and whether claims made under the old SOP are subject to the new SOP on commencement.

The instrument itself does not record any litigation history. It is a stand‑alone RMA determination and provides no case citations within its text. Accordingly:

• No judicial or tribunal decisions are cited in the SOP: The text contains no references to litigation, judicial interpretations, or precedent decisions. It is a pure administrative instrument.

• Implication for claim disputes: While the SOP contains no litigation history, its practical application to individual claims can generate disputes that may be litigated or reviewed in administrative or judicial fora under the VEA and MRCA systems and broader administrative law. The SOP does not state the procedural avenues for review of determinations that apply it; those are supplied by the enabling statutes and general administrative law practice.

• No recorded direct challenges in the instrument: Because the instrument is text only, it does not reflect any prior challenge to the RMA’s view. To identify any litigation that relates to the RMA’s application of SOPs for eating disorders one must search external tribunal or court records. The instrument itself provides no such material.

Practitioners intending to litigate or appeal decisions that rely on this SOP must therefore:

• Identify the statutory review and appeal mechanisms in the VEA and MRCA.
• Prepare clinical and factual evidence that takes account of the SOP’s fixed criteria and temporal windows.
• Anticipate argument about application‑level issues, such as the meaning of "related to the relevant service", the identification of "clinical onset" or "clinical worsening" dates, and the sufficiency of evidence to prove factors like bullying or food insecurity.

Because the SOP is new for commencement 28 January 2025, litigation or administrative review decisions applying it will only begin to accumulate after that date. This instrument does not supply litigation precedent.

This SOP contains several features that can catch practitioners and claimants unprepared unless attention is paid to the text and its precise terms.

• DSM‑centred definition controls over ICD coding: Although ICD‑10‑AM codes are noted (s 7(7)), subsection 7(2) instructs that the meaning of "eating disorder" for the SOP is the DSM‑derived definition. Practitioners who rely solely on hospital coding or non‑DSM diagnostic labels risk mismatch with the SOP’s textual diagnosis requirement. Ensure clinical reports map symptoms to the DSM‑derived criteria reproduced in subsection 7(2).

• Exclusions are narrow but counterintuitive: The SOP expressly excludes "anorexia", "orthorexia nervosa", and "polyphagia" (s 7(2)(3)). Note that "anorexia nervosa" is included but "anorexia" is excluded. Practitioners should take care about nomenclature in clinical notes, and ensure that any diagnosis claimed aligns with the specific DSM labels used in the SOP. Ambiguous shorthand in medical records may lead to disputes about whether the disorder falls within the SOP’s covered disorders.

• Temporal windows are disorder and factor specific: Each factor in section 9 has its own timing requirement relative to "clinical onset or clinical worsening". Examples:

  • Category 1A stressor must be within 1 year of onset/worsening for certain disorders (s 9(1));
  • Bullying must be within 2 years for the same set of disorders (s 9(2));
  • Clinically significant mental health disorder must be within 12 months (s 9(3));
  • Food insecurity requires a continuous 3‑month period at the time of onset/worsening for binge‑eating disorder (s 9(6));
  • Type 1 diabetes must exist for at least 3 months prior to onset/worsening of particular disorders (s 9(7)). Failure to align the evidence with these windows may result in a disconnection between the claimed factor and the timing required by the SOP.

• "Clinical worsening" limited where disorder pre‑existed or was contracted before/during service but did not arise out of service: Section 10(2) restricts the application of clinical worsening aspects of factors to situations of material contribution or aggravation where the disorder pre‑existed or was contracted before or during service but did not arise out of service. This casts a narrower net for post‑service worsening in certain situations and requires careful legal and clinical framing of when a condition "arose out of" service versus when it pre‑existed and was aggravated.

• "Clinically significant disorder of mental health" does not require treatment: The Schedule defines that such a disorder is "of sufficient severity to warrant ongoing management" and includes a note that "to warrant ongoing management does not require that any actual management was received or given for the condition" (Schedule 1). This reduces the evidentiary burden relating to proof of treatment, but it requires credible medical evidence that the disorder reached the threshold of significance, even if no treatment was accessed.

• Vague or broad factors need precise evidence: Certain factors, such as "inability to obtain appropriate clinical management for eating disorder before clinical worsening" (s 9(8)), are phrased by reference to a negative event and contain no express temporal window. Proving inability to obtain appropriate care will require documentary proof of service denials, waitlists, geographical or administrative barriers, or contemporaneous clinical notes, and may be contested on what constitutes "appropriate clinical management".

• Definition of "bullying" is broad: The Schedule defines bullying as repeated unwanted aggressive behaviour involving an observed or perceived imbalance of power and provides broad examples including cyberbullying (Schedule 1). Evidence for bullying will therefore need to show repetition, power imbalance, and the specified temporal window relative to clinical onset. Institutional records, contemporaneous complaints, witness statements, and service records may be required.

• "Category 1A stressor" includes life‑threatening illness: The Schedule lists severe events including "experiencing a life‑threatening event including an illness or injury" (Schedule 1 category 1A). That could be a non‑violent event and therefore expands the type of qualifying stressor beyond combat or assault. Practitioners must be ready to document the life‑threatening nature and timing of such events.

• Narrow definition of "relevant service": The Schedule’s definition of relevant service excludes certain categories by express qualification (for example, eligible war service other than operational service, defence service other than hazardous and British nuclear test defence service) (Schedule 1 relevant service). A claim will not attract the SOP unless the person’s service fits that definition; practitioners should verify the service classification carefully.

• Death causation needs proximate contribution: For death claims, the SOP requires that death from a terminal event or condition was contributed to by the eating disorder (s 7(4)). The Schedule provides examples of terminal events. This requires medico‑legal evidence linking the disorder to the terminal event as a contributing cause, not merely as a coexistent diagnosis.

• Interaction with other SOPs can complicate causation chains: Section 11 requires that where a factor refers to an injury or disease covered by another SOP, that other SOP applies. Practitioners must audit whether any factors invoke or depend on other SOPs, and collate the separate evidentiary standards accordingly.

Being mindful of these textual details will reduce the risk of avoidable evidentiary failures or mischaracterisation of conditions when assembling and presenting claims.

Practical steps for claimants, medical practitioners, and decision makers in order to align submissions and determinations with the SOP’s requirements.

For claimants and representatives:

1. Establish a DSM‑aligned diagnosis:

   • Obtain a contemporaneous or retrospective clinical opinion that maps the person’s presentation to the DSM‑derived criteria as reproduced in subsection 7(2). The SOP treats DSM‑derived text as the statutory meaning for eating disorders (s 7(2), s 7(7)).
   • Ensure the report identifies the specific disorder by DSM nomenclature rather than informal shorthand. Given the exclusions of "anorexia" and "orthorexia nervosa", specificity matters.

2. Fix dates for clinical onset or clinical worsening:

   • Secure clinical records (primary care, psychiatric, hospital outpatient, admission notes) that specify the earliest reasonable date of onset or the date(s) of clinical worsening, with clinician commentary where precise dating is uncertain.
   • Align those dates with the SOP’s temporal windows for the factors intended to be relied upon (s 9).

3. Assemble factor‑specific evidence:

   • Category 1A stressor: Document the life‑threatening event, serious physical attack, sexual assault, or captivity, and show it occurred within 1 year of onset/worsening when relying on s 9(1). Include medical records, incident reports, witness statements, or police reports where available.
   • Bullying: Compile complaints, unit reports, contemporaneous emails/texts, witness statements, or other documentation showing repeated unwanted behaviour and power imbalance within 2 years of onset/worsening (s 9(2); Schedule 1 bullying).
   • Clinically significant mental disorder: Obtain diagnosis and clinician statements confirming the disorder was of sufficient severity to warrant ongoing management, occurring within 12 months of onset/worsening (s 9(3); Schedule 1 clinically significant disorder).
   • Childhood abuse/neglect: Provide historical evidence or credible contemporaneous records, psychological reports, or affidavits that the abuse or neglect occurred before age 18 and preceded onset/worsening (s 9(4)-(5)).
   • Food insecurity: For binge‑eating disorder claims, produce evidence of continuous food insecurity for at least 3 months contemporaneous with onset/worsening, such as welfare records, housing records, income statements, or social worker reports (s 9(6); Schedule 1 food insecurity).
   • Type 1 diabetes: Provide medical records confirming diagnosis and duration for at least 3 months prior to onset/worsening when relying on s 9(7).
   • Inability to obtain appropriate clinical management: Collect appointment records, referral letters, waitlist evidence, correspondence showing service denial, geographic access issues, or other documents proving inability to obtain care before clinical worsening (s 9(8)).

4. Prove the relationship to relevant service:

   • Demonstrate that the factor is related to the person’s relevant service as defined in the Schedule. Provide service records, unit diary entries, incident reports, postings, and administrative evidence tying the factor to service circumstances (s 10(1); Schedule 1 relevant service).

5. For death claims:

   • Obtain the death certificate, coronial findings (if any), and treating clinician’s opinions that the terminal event was contributed to by the eating disorder. The Schedule lists terminal events such as pneumonia and respiratory failure that will often be proximate causes (s 7(4); Schedule 1 terminal event).

For medical practitioners preparing opinions:

1. Use DSM‑5‑TR mapping: Identify each diagnostic criterion and indicate which are met, and provide an opinionated date or period for clinical onset and any clinically significant worsening. The SOP relies on DSM‑derived text as the determinative definitional source (s 7(2); Schedule 1 DSM‑5‑TR).

2. Address temporal links explicitly: State whether and when each factor occurred relative to onset/worsening, and opine on causation or material contribution where appropriate. For "clinically significant disorder" note that absence of treatment does not preclude the disorder meeting the threshold (Schedule 1).

3. Address "related to relevant service": Offer clinical opinion on how the factor is related to the person’s service, and whether it is more probable than not that the service exposure contributed to onset or worsening.

4. If multiple factors and other SOPs are implicated: Explain interaction effects and whether co‑morbid injuries or diseases might mediate or confound causation, and reference other SOPs where relevant (s 11).

For decision makers and administrators:

1. Apply the SOP’s factor thresholds and temporal windows: Confirm at least one factor is established on the balance of probabilities, that timing aligns with clinical onset/worsening, and that the factor is related to relevant service (s 9; s 10).

2. Use DSM definitions as the diagnostic standard: Treat the DSM‑derived text in subsection 7(2) as the operative definition for eating disorder; use ICD‑10‑AM codes only as cross‑reference (s 7(7)-(8)).

3. Check for cross‑SOP references: Identify whether any factor invokes another SOP and apply that SOP’s requirements in accordance with section 11.

4. Handle evidentiary gaps prudently: Where onset dates or factor evidence is unclear, seek further clinical clarification or administrative records. Consider whether contemporaneous documents exist to corroborate bullying, food insecurity, inability to access care, or life‑threatening events.

5. Record reasoning about "clinical worsening" nuance: If the eating disorder pre‑existed or was contracted before/during service but did not arise out of service, be explicit about the material contribution or aggravation analysis governed by section 10(2).

6. For death claims, seek and assess medico‑legal causation: Ensure medical opinions address whether the eating disorder contributed to the terminal event listed in the Schedule, and whether the contribution meets the balance of probabilities.

Documentation checklist to comply with the SOP:

• DSM‑aligned diagnostic report specifying diagnosis, criteria met, and dates of onset/worsening (s 7(2)).
• Medical notes, admissions, outpatient records, psychiatric assessments with dates.
• Service records linking the factor to relevant service classification (Schedule 1 relevant service).
• Records supporting specific factors: incident reports for category 1A stressor, complaints and witness statements for bullying, psychiatric diagnoses for comorbid mental disorders, historical records for childhood abuse/neglect, welfare or housing records for food insecurity, diabetes treatment records, correspondence demonstrating inability to access care.
• For death claims, coronial reports, death certificate, and treating clinician opinions linking terminal event to the eating disorder (s 7(4), Schedule 1 terminal event).

Following these steps aligns submissions with the SOP’s textual requirements and reduces the risk of refusal on technical grounds such as missing temporal alignment, insufficient nexus to service, or failure to use DSM‑based diagnostic language.