Statement of Principles concerning eosinophilic oesophagitis (Reasonable Hypothesis) (No. 29 of 2022)

The instrument rests on several tightly described legal-medical concepts. First, eosinophilic oesophagitis (EoE) is defined operationally in s6(2). EoE is described as a chronic, immune‑mediated oesophageal disease characterised by oesophageal dysfunction symptoms together with eosinophil‑predominant inflammation of the oesophageal epithelium. The instrument supplements that core definition with four notes which specify typical adult symptoms (note 1), a histological threshold for eosinophil predominance (peak values of at least 15 eosinophils per high‑power field on oesophageal biopsy, note 2), endoscopic features that increase diagnostic suspicion (note 3), and the requirement that a clinical assessment should evaluate alternative causes of oesophageal tissue eosinophilia (note 4) (s6(2) notes 1-4). These notes are part of the instrument’s definition and therefore relevant to the evidentiary assessment of a claim.

Second, death from EoE is defined to include a death from a terminal event or condition that was contributed to by the person’s EoE. The instrument defines “terminal event” in Schedule 1 to include proximate or ultimate causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure or cessation of brain function (s6(3); Schedule 1). That means the Statement recognises indirect pathways from EoE to death, where a terminal event was contributed to by the disease.

Third, the instrument is expressly framed around the “reasonable hypothesis” standard. Section 8 states that “at least one” of the listed factors must exist “before it can be said that a reasonable hypothesis has been raised connecting eosinophilic oesophagitis or death from eosinophilic oesophagitis with the circumstances of a person’s relevant service.” The factors are rules of causation for the reasonable hypothesis threshold: the presence of any one is the minimum required to meet that threshold.

Fourth, the list of causative or aggravating factors is tightly specified (s8). These include pharmacological exposures (aspirin desensitisation at an average of at least 600 mg per day for at least 3 months prior to onset or worsening; carbamazepine daily for at least 7 days prior to onset or worsening), oral or sublingual allergen immunotherapy at the time of onset or worsening, organ or tissue transplantation prior to onset or worsening (excluding corneal transplant), and inability to obtain appropriate clinical management for EoE (s8(1)-(9)). The instrument treats onset and clinical worsening separately and provides distinct but overlapping factors for each.

Fifth, the relationship to service is an explicit legal gate. Section 9(1) requires that any factor in s8 be related to the person’s relevant service as defined in Schedule 1 (which lists the categories of VEA and MRCA service). Section 9(2) imposes an additional limitation: the factors in s8(5)-(9), which concern clinical worsening or aggravation, apply only where the person’s EoE was suffered or contracted before or during (but did not arise out of) the person’s relevant service. In short, the instrument draws a line between initial causation during service and later material contribution or aggravation.

Sixth, the instrument contains an interaction rule with other Statements of Principles (s10). If a factor in s8 refers to another injury or disease for which a Statement has been determined under s196B(2), then the factors in that other Statement apply according to its terms as in force. This is an explicit mechanism for cross-referencing and deference to other Statements where overlap exists.

Finally, the Schedule 1 dictionary supplies key legal definitions: “organ or tissue transplantation” (including transplantation of a substance obtained from organ or tissue), “relevant service” (listing VEA and MRCA categories) and the statutory acronyms “VEA” and “MRCA” (Schedule 1). These definitions control how the main text is applied.

Collectively, those concepts convert clinical and histological criteria into an administrable framework for assessing whether a reasonable hypothesis connects EoE (or death from it) to relevant service across the VEA/MRCA claims architecture.

This Statement of Principles affects a narrow set of actors and decisions in the veterans’ entitlements and military compensation sphere. Primarily, it affects claimants,veterans, members of Peacekeeping Forces, or members of the Forces,whose claims fall within the statutory claims described in section 4 (claims to which s120A of the VEA or s338 of the MRCA apply). The instrument is addressed to the question of whether a reasonable hypothesis exists connecting a person’s eosinophilic oesophagitis or death from it to their relevant service (s8). Therefore, any person asserting that their EoE onset or clinical worsening is connected to relevant service will be affected insofar as decision-makers use this Statement when determining whether that statutory threshold has been met.

Decision-making bodies that administer claims under the VEA and MRCA will also be affected by the instrument. The Repatriation Medical Authority (RMA) made this Statement under s196B(2) of the VEA (s3), and the instrument is therefore intended to be used by decision-makers in assessing medical causation for claims covered by the referenced sections. The instrument does not itself name the administrative decision-maker, nor does it create benefits; it provides medical‑scientific criteria to be applied in the decision-making process.

Medical practitioners who provide clinical evidence for claims will be affected because the Statement defines the clinical and histological features relevant to a claim (s6(2) and note 2 regarding biopsy counts). The specified factors in s8 (for example, medication dosages and durations, immunotherapy, transplantation) frame the kinds of clinical history and documentation that will be probative in meeting the reasonable hypothesis threshold. For example, the aspirin desensitisation factor specifies an average daily dose of at least 600 mg for at least three months prior to onset or worsening (s8(1) and s8(5)), and carbamazepine must have been taken daily for at least seven days prior to onset or worsening (s8(2) and s8(6)). Clinicians supplying evidence will therefore need to link such exposures temporally and substantively to onset or worsening as described.

OtherStatements of Principles and their administrators are affected through s10, which requires that where a factor in s8 refers to another injury or disease already covered by a Statement under s196B(2), the factors in that other Statement apply according to its terms. That creates an interaction domain where two Statements potentially control causal assessment.

Lastly, the instrument touches family members or dependants in an indirect way because it defines “death from eosinophilic oesophagitis” to include death from a terminal event contributed to by EoE (s6(3); Schedule 1 definition of terminal event). Where a death claim under the applicable statutory provisions is made, the presence or absence of the factors and their relation to relevant service will be determinative for the reasonable hypothesis stage.

Inclusion and exclusion effects are concrete: the instrument excludes corneal transplant from the transplant factor (s8(4) note; Schedule 1 definition notes organ or tissue transplantation but s8 excludes corneal transplant), it requires biopsy evidence thresholds (s6(2) note 2), and it limits application of certain factors to cases where EoE pre‑existed or was contracted before or during service but did not arise out of service (s9(2)). Those definitional choices determine which claimants will find the instrument supportive and which will not.

The instrument does not create affirmative duties or statutory rights in the form of entitlements or penalties. Instead, it prescribes evidential criteria that must be met before a reasonable hypothesis can be said to exist connecting EoE or death from EoE with relevant service. Those criteria function as legal thresholds used by decision-makers when exercising statutory functions under the VEA and MRCA.

Duty of applicability: Decision-makers assessing claims to which section 120A of the VEA or section 338 of the MRCA apply must take this Statement into account because it is expressed to apply to such claims (s4). The instrument imposes an obligation on assessing authorities or tribunals to consider the factors listed when evaluating whether the reasonable hypothesis threshold is met, insofar as the instrument is the RMA’s statement determined under s196B(2) (s3, s7-s8).

Evidentiary floor: Section 8 establishes a minimum evidentiary requirement: at least one of the listed factors must exist to raise a reasonable hypothesis linking EoE or death from EoE to relevant service. That is a prescriptive rule about the existence of an identifiable causal factor. It does not state that other evidence cannot be considered, but it sets a baseline which, if not met, precludes saying a reasonable hypothesis has been raised under the terms of this Statement.

Temporal and relational duties: Section 9 creates a duty to link any factor in s8 to the person’s relevant service. Section 9(2) further limits the application of factors in s8(5)-(9) (those relating to clinical worsening or aggravation) to situations where the person’s EoE was suffered or contracted before or during relevant service but did not arise out of that service. That places a duty on assessors to make two separate, sequential findings before applying the worsening factors: (a) that EoE existed before or during service and (b) that the factor materially contributed to or aggravated the EoE.

Interaction duty: Section 10 imposes a duty to apply the factors of any other relevant Statement of Principles when a factor in s8 refers to an injury or disease already covered by such a Statement. Assessors must therefore consult overlapping Statements and apply the other Statement’s factors “in accordance with the terms of that Statement of Principles as in force from time to time” (s10(1)-(2)).

Clinician evidence obligations (implicit): While the instrument does not directly command clinicians, the definition and notes in s6(2) imply that clinical evidence should include documentation of symptoms related to oesophageal dysfunction, histological findings of eosinophil counts (note 2), endoscopic observations that may support diagnosis (note 3), and evaluations ruling out other causes of oesophageal eosinophilia (note 4). These are de facto expectations for any medical evidence tendered in support of a claim.

No new statutory entitlements or penalties: The instrument does not grant benefits directly nor prescribe penalties for non-compliance. Its legal effect is to guide whether the statutory prerequisite (reasonable hypothesis connecting condition to service) is satisfied. Consequently, the “rights” it confers are procedural and evidentiary: the right of a claimant to have their evidence measured against the factors in this Statement and the reciprocal duty on decision-makers to consider those factors in claims covered by the cited statutory sections.

Definitions that affect duties and rights: Schedule 1 defines “relevant service,” including operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike and non-warlike service under the MRCA. That definition governs whether a person’s service qualifies as relevant, which in turn affects whether the instrument applies to their claim (Schedule 1; s4).

In short, the instrument prescribes the evidentiary duties for establishing a reasonable hypothesis and imposes a duty on decision-makers to apply those criteria in appropriate claims, but it does not create new benefit rights or criminal sanctions itself.

The Statement of Principles contains no provisions imposing criminal penalties, civil fines, or administrative sanctions. It is an administrative medical‑scientific instrument made under s196B(2) of the VEA (s3) and its role is to provide criteria for assessing whether a reasonable hypothesis connects eosinophilic oesophagitis or death from eosinophilic oesophagitis with relevant service. The instrument does not itself provide enforcement mechanisms, complaint processes, or appeal rights. Those procedural or remedial matters lie in the parent statutes (VEA and MRCA) and associated administrative regimes, none of which are amended, altered or further specified by this instrument.

Enforcement in practical terms therefore operates indirectly: decision-makers responsible for adjudicating claims under the relevant statutory provisions must apply the Statement’s factors when determining whether the reasonable hypothesis threshold is met (s4, s8). If a decision-maker fails to follow the statutory requirements that incorporate the RMA’s Statement of Principles, any challenge or remedy would have to be pursued under the procedural and judicial review mechanisms available under the VEA, MRCA or administrative law. The Statement itself contains no enforcement clauses or sanctioning powers.

There is no internal compliance regime set out in the Statement that compels clinicians, hospitals or other third parties to produce records. The evidentiary requirements implied by the instrument (for example, histology demonstrating at least 15 eosinophils per high‑power field, s6(2) note 2) will be relevant to the proving of a claim, but the instrument does not create statutory powers to compel the production of those records. Any compulsion would arise under other laws or administrative processes.

Because the instrument cross-references other Statements of Principles where factors overlap (s10), there is an implementation risk that inconsistent or out-of-date cross-references could produce disputes over which Statement governs a particular factor. Again, the Statement provides no dispute-resolution or enforcement procedure for resolving such interpretive conflicts; resolution would occur through the applicable administrative and legal review paths under the VEA/MRCA framework.

Finally, the instrument specifies temporal and relational requirements,such as the requirement that certain aggravating factors apply only where EoE was suffered or contracted before or during service but did not arise out of service (s9(2)). Administrative decisions that misapply these limits could be subject to review, but that remedial avenue is not part of the Statement itself.

In short, the instrument is not an enforcement statute; it is an administrable piece of evidence law designed to direct how adjudicators treat medical causation in claims. Any penalties, sanctions or enforcement steps are the province of the wider statutory and administrative apparatus that gives effect to the VEA and MRCA.

The Statement of Principles is an instrument made under subsection 196B(2) of the VEA (s3) and expressly applies to claims to which section 120A of the VEA or section 338 of the MRCA apply (s4). Its interaction with other laws is therefore primarily in the context of statutory claims processes under the VEA and MRCA. The Statement does not amend those Acts, nor does it itself create entitlements; rather, it is a medical‑scientific statement intended to be applied by decision-makers when assessing the statutory threshold that a condition is connected to relevant service.

Definitions in Schedule 1 expressly incorporate the meaning of “relevant service” drawn from the VEA and MRCA frameworks: relevant service includes operational, peacekeeping, hazardous and British nuclear test defence service under the VEA, and warlike and non‑warlike service under the MRCA (Schedule 1). As such, whether the Statement applies to a particular claimant depends on the statutory classification of that person’s service under the parent Acts.

Section 10 provides an explicit interaction rule with other Statements of Principles determined under s196B(2) of the VEA. If a factor in s8 refers to an injury or disease that is itself the subject of another Statement, then the factors in that other Statement apply in accordance with that Statement’s terms as in force from time to time (s10). That is a direct legal mechanism to coordinate overlapping medical causation statements and to avoid conflicting or duplicative causal frameworks. Practically, this means assessors must identify whether any factor in s8 invokes another disease, then consult and apply the relevant Statement’s factors.

The Statement references other medical conditions and processes that are typically regulated by health law or clinical guidelines,examples include organ or tissue transplantation, allergen immunotherapy, and aspirin desensitisation. The Statement does not displace or regulate those clinical practices; it simply recognises them as possible causal or aggravating factors in the statutory causation assessment.

Because the Statement sets out medical criteria (for example, the histological threshold of at least 15 eosinophils per high‑power field on oesophageal biopsy, s6(2) note 2), it will interact with evidentiary rules under administrative law and procedural rules governing claims: assessors will need to decide whether the clinical evidence produced meets those medical criteria. The Statement itself does not set evidentiary standards (for example, standards of proof) nor does it prescribe procedures for obtaining medical records; those matters remain governed by the VEA, MRCA, and general administrative law principles.

There are no cross-references to criminal, taxation, employment, or other regulatory regimes in the instrument. It also does not contain saving or transitional provisions with respect to earlier Statements; it does, however, contemplate that other Statements may remain in force and be applied in conjunction (s10).

Finally, the Schedule 1 dictionary defines “terminal event” for the purpose of connecting death to EoE (Schedule 1). That definition will interact with statutory provisions and policy settings that govern death-related claims under the VEA and MRCA, insofar as such claims rely on a medical determination that death was contributed to by the terminal event linked to EoE.

In sum, the instrument interacts with other laws by (a) operating within the VEA/MRCA claims architecture, (b) cross-referencing other Statements of Principles made under the same VEA provision, and (c) imposing medical criteria that must be met in the evidentiary assessment of claims, while leaving procedure, remedies and enforcement to the parent statutes and administrative law.

The instrument bears the date 4 March 2022 and expressly commences on 4 April 2022 (s2). It is identified as Statement of Principles No. 29 of 2022 concerning eosinophilic oesophagitis (s1). The operative authority for the instrument is subsection 196B(2) of the Veterans’ Entitlements Act 1986 (s3). Beyond the dates given and the identifying number, the instrument does not record any prior versions, previous instruments, or earlier Statements relating to eosinophilic oesophagitis. It also does not include transitional provisions, repeal clauses, or references to proclamations for amendment. The instrument makes no provision for sunset or automatic expiry.

Section 10 contemplates that the factors in other Statements of Principles “as in force from time to time” will apply where a factor in this instrument refers to an injury or disease already covered by another Statement. That phrasing anticipates that other Statements may be amended subsequently and directs assessors to apply those other Statements as they exist at the relevant time. However, the Statement itself contains no internal mechanism for amendment beyond the general statutory processes that allow the Repatriation Medical Authority to determine Statements of Principles under s196B(2) of the VEA.

No express saving provisions are included to preserve or supersede any existing Statements; practical effect will therefore depend on the RMA’s overall body of Statements and any subsequent determinations. The instrument’s commencement a month after the date on the face of the instrument suggests a deliberate commencement date, but there is no recorded history of consultation, explanatory memorandum, or parliamentary passage text in the instrument itself. The instrument also does not record whether it replaces any earlier Statement concerning EoE.

If, in future, the RMA amends this Statement, the s10 wording implies that assessors must take account of contemporaneous versions of other Statements where cross-reference occurs. The instrument does not establish any transitional or retrospective effect for amendments; how an amendment applies to claims in progress would be determined by standard statutory and administrative principles outside the instrument.

Therefore, the recorded amendment history in the text is limited to the instrument’s making date (4 March 2022) and its commencement date (4 April 2022). No further amendment or prior-instrument history is contained in the document provided.

The Statement of Principles itself contains no record of litigation, judicial interpretation, appeals or case law. The instrument is a statutory administrative instrument made by the Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (s3); any litigation arising from its application would occur in the context of claims under the VEA or MRCA. The provided instrument text does not identify any decisions, appeals, tribunal outcomes or judicial reviews that interpret its content.

Because the instrument functions as an evidentiary or determinative statement for the reasonable hypothesis standard, litigation or review would likely focus on whether decision-makers correctly applied the Statement’s factors, correctly identified the link to relevant service, or correctly invoked other Statements under s10. However, none of those potential disputes are reflected in the instrument text, and no cases are cited. The instrument does not name, quote or reference any judicial authorities, nor does it annotate its provisions with references to precedent.

Where litigation exists or arises externally, it would not be recorded in the Statement itself. Practitioners seeking to identify litigation about the Statement will need to look to tribunal determinations, Federal Court or Administrative Appeals Tribunal decisions concerning claims in which this Statement was applied. The instrument as presented contains no litigation history and therefore provides no guidance on how courts or tribunals have construed its factors, definitions or interaction provisions.

In summary, there is no litigation history recorded in the instrument; any legal challenges or interpretive authorities developed later would need to be located outside the document in administrative law and veterans’ law decisions applying this Statement.

This Statement contains a number of drafting and application features that can catch claimants, clinicians and decision-makers if not carefully noted.

1. Reasonable hypothesis threshold tied to explicit factors (s8). The Statement says that at least one of the enumerated factors must exist “before it can be said that a reasonable hypothesis has been raised” connecting EoE or death from EoE to service. Practically, the presence of other persuasive evidence not listed in s8 does not, on the face of the instrument, satisfy the minimum posture; assessors will be guided by the specified list. The practical consequence is that claimants lacking evidence of one of these factors may fail at the reasonable hypothesis stage even if they have other circumstantial medical evidence.

2. Distinct treatment of onset vs clinical worsening (s8(1)-(4) vs s8(5)-(9)). The Statement makes separate lists for causation of onset and for factors that materially contribute to or aggravate EoE. Misreading these as interchangeable can produce error. For instance, aspirin desensitisation and carbamazepine appear in both the onset and worsening lists but the legal application to a claim depends on whether the claimant is alleging initial causation or aggravation/worsening.

3. Temporal linkage and pre-existence requirement for worsening factors (s9(2)). The factors in s8(5)-(9) (worsening factors) apply only where the person’s EoE was suffered or contracted before or during,but did not arise out of,the person’s relevant service. That is a specific factual sequencing requirement. If the EoE arose out of service, these aggravation factors do not apply as the legal framework describes them. The need to establish that EoE pre‑existed or was contracted before/during service is a distinct factual hurdle.

4. Narrow clinical definition and biopsy threshold (s6(2) note 2). The histological criterion of at least 15 eosinophils per high‑power field on oesophageal biopsy is explicit. Claims with lower counts or without documented biopsy evidence may not meet the instrument’s operative definition. Note 4 also expressly requires evaluation of alternative causes of oesophageal eosinophilia, so incomplete differential diagnosis may weaken a claim.

5. “Inability to obtain appropriate clinical management” is a factor (s8(9)) but not defined. This is an imprecise concept in the instrument. The absence of a statutory definition or examples means assessors must interpret what evidence suffices to show inability to obtain appropriate care. That creates a potential evidentiary and interpretive gap that may lead to disputes.

6. Transplantation factor excludes corneal transplant (s8(4) and Schedule 1). The instrument records organ or tissue transplantation as a factor but explicitly excludes corneal transplant. Practitioners should not assume all transplants are relevant. Schedule 1 defines organ or tissue transplantation broadly to include substances obtained from organ or tissue, but the exclusion in s8(4) is decisive.

7. Drug exposure specifics (s8(1)-(2) and s8(5)-(6)). The aspirin desensitisation factor requires an average of at least 600 mg of aspirin per day for at least three months before onset or worsening; carbamazepine must have been taken daily for at least seven days before onset or worsening. Shorter or intermittent exposures will not meet these express thresholds.

8. Cross-reference to other Statements (s10). If a listed factor refers to another disease covered by a different Statement of Principles, assessors must apply that other Statement’s factors as they are in force. This can complicate assessment where an alleged causal chain involves multiple conditions; the assessor must identify and apply the correct Statement(s) at the relevant version.

9. Death linkage via terminal events (s6(3) and Schedule 1). Death from EoE is not limited to immediate catastrophic oesophageal complications; the Statement recognises death from terminal events (for example, pneumonia, respiratory failure) if contributed to by EoE. Establishing contribution to such terminal events requires clinical linkage which may be contested.

10. No procedural or evidentiary rules contained in the instrument. The Statement prescribes causal factors but does not set evidentiary standards (for example, balance of probabilities or other), nor does it prescribe how to prove service‑relation. Practitioners must therefore rely on the parent statutes and administrative law to fill those procedural gaps, which can create uncertainty at the margins.

Careful attention to the instrument’s precise wording,especially the temporal requirements, the narrow histological threshold, the explicit dosage/duration metrics for drug-related factors, and the undefined “inability to obtain appropriate clinical management” factor,will reduce misapplication risk.

For claimants, clinicians and advisers preparing or assessing claims that rely on this Statement, compliance means assembling evidence that tracks the instrument’s specific requirements and the relational tests set out in section 9.

1. Establish the diagnosis as defined in s6(2). Clinical documentation should demonstrate symptoms of oesophageal dysfunction (note 1), and histology confirming eosinophil‑predominant infiltration of the oesophageal epithelium with peak values of at least 15 eosinophils per high‑power field on oesophageal biopsy (s6(2) note 2). Endoscopy reports noting rings, furrows, exudates, oedema, stricture, narrowing or crepe‑paper mucosa (s6(2) note 3) will assist. Clinical notes should also record that alternative causes of oesophageal eosinophilia,such as gastro-oesophageal reflux disease, Crohn disease, infections and connective tissue disorders,were considered and evaluated (s6(2) note 4).

2. Prove presence of at least one listed factor in s8. For each asserted factor, gather contemporaneous medical records, pharmacy dispensing records, hospital discharge summaries, procedural notes or specialist letters that document the required exposure or event and its timing relative to clinical onset or worsening:

   • Aspirin desensitisation: evidence of average at least 600 mg/day for at least three months prior to onset or worsening (s8(1), s8(5)). Pharmacy records, specialist allergy clinic records and desensitisation protocols will be relevant.
   • Carbamazepine: evidence of daily use for at least seven days prior to onset or worsening (s8(2), s8(6)). Prescriptions, dispensing records and clinical notes are required.
   • Oral or sublingual allergen immunotherapy: proof of receiving such therapy at the time of onset or worsening (s8(3), s8(7)). Immunotherapy clinic records should state modality (oral/sublingual) and timing.
   • Organ or tissue transplantation: documentation of the transplant (excluding corneal transplant) prior to onset or worsening (s8(4), s8(8)). Surgical discharge summaries, transplant records and pathology reports will be relevant; note Schedule 1’s definition includes substances obtained from organ or tissue.
   • Inability to obtain appropriate clinical management: contemporaneous evidence demonstrating attempted access to appropriate care and barriers encountered (s8(9)). This may include referrals, appointment records, correspondence showing denial or unavailability of treatment, or military service records evidencing lack of access; the instrument does not define the precise evidentiary standard, so detailed contemporaneous documentation will strengthen a claim.

3. Link the factor to relevant service per s9. Any factor established must be shown to be related to the person’s relevant service as defined in Schedule 1. Practically, that means establishing both factual connection (for example, that aspirin desensitisation occurred while serving in theatre or as part of service medical treatment) and statutory classification of the service (operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, warlike or non-warlike under the MRCA) (Schedule 1; s9(1)). Service records, medical treatment records maintained by the service, deployment records and unit logs will be relevant.

4. For aggravation claims, observe the pre‑existence requirement (s9(2)). If relying on s8(5)-(9) (worsening factors), ensure that evidence demonstrates the person’s EoE was suffered or contracted before or during relevant service and that it did not arise out of the person’s relevant service. Medical history prior to service entry, service medical records and early post‑service clinical records will assist in establishing pre‑existence.

5. Consider interaction with other Statements (s10). If a factor in s8 refers to another disease or injury already covered by a different Statement of Principles under s196B(2), identify that Statement and ensure the factors in that other Statement are satisfied and evidenced according to its current terms. Cross-reference relevant Statements and follow their specifications.

6. Document causal links for death claims. For claims alleging death from EoE, assemble clinical and coronial records that demonstrate the terminal event listed in Schedule 1 was contributed to by EoE (s6(3); Schedule 1). Coroner’s reports, death certificates, hospital records of the terminal event and pathology reports that link the terminal event to an antecedent of EoE will be material.

7. Use contemporaneous records where possible. Because the Statement specifies precise time windows for drug exposures and events, contemporaneous prescribing, dispensing and treatment records are the most persuasive. Retrospective recollection without records is less likely to satisfy the instrument’s minimum requirements.

8. Prepare to address the undefined “inability to obtain appropriate clinical management” (s8(9)). Given the lack of definition, supply as much contextual evidence as possible: attempts to obtain care, refusals, service‑related barriers, dates and locations where appropriate care was unavailable, and any alternative measures taken. Provide clinical statements linking the lack of care to subsequent clinical deterioration if alleging material contribution.

9. Anticipate cross-checks against differential diagnosis (s6(2) note 4). Ensure that clinical assessments document that other causes of oesophageal eosinophilia were considered and, where relevant, excluded. Specialist gastroenterology or allergy/immunology reports addressing differential diagnosis will be useful.

10. Be precise about transplantation exclusions. If a transplant occurred, confirm that it was not a corneal transplant (which is excluded under s8(4)), and provide operative and transplant records to show the nature of the transplant (s8(4); Schedule 1).

11. Maintain chronology. Prepare a clear timeline that links the relevant service periods (as defined in Schedule 1), the onset or worsening of symptoms, any exposures or treatments relied on under s8, and all supporting clinical documentation. Section 9 requires that factors be related to relevant service; a precise chronology will assist assessors in applying that legal test.

12. Understand procedural context beyond the Statement. The Statement does not set out procedural steps to lodge a claim or appeal a decision. Claimants and advisers should therefore follow the lodgement, evidence and appeal procedures established under the VEA and MRCA and any relevant administrative processes.

Following these steps aligns evidence collection and presentation with the instrument’s specific criteria and temporal/relational limits. The objective is not merely clinical proof of disease but establishing the narrow factual linkages the Statement requires so that a reasonable hypothesis can be said to be raised.