Statement of Principles concerning epilepsy (Reasonable Hypothesis) (No. 84 of 2022)

The SoP organises its medical-scientific predicates around a small set of core concepts that determine whether epilepsy or death from epilepsy can be linked to relevant service for claims under the VEA and MRCA. Those concepts are set out primarily in sections 7-11 and the Schedule 1 - Dictionary.

1. Definition of the condition: “Epilepsy” is defined as a chronic, recurring, paroxysmal brain dysfunction caused by sudden, abnormal, excessive neuronal discharge manifesting with seizures (s7(2)(a)). The definition expressly includes status epilepticus, generalised epilepsy and focal epilepsy, and expressly excludes a list of other seizure-like phenomena and conditions (s7(2)(b)-(c)). “Death from epilepsy” includes deaths from a terminal event or condition that were contributed to by the person’s epilepsy (s7(3); Schedule 1, terminal event).

2. Reasonable hypothesis threshold: The RMA frames the instrument as evidence sufficient to “raise a reasonable hypothesis” connecting the condition with service (s9). The instrument is therefore a causation-threshold instrument: one or more listed factors must exist, and they must be related to the person’s relevant service (s9; s10(1)). The instrument does not itself set out subsequent decision steps under the VEA or MRCA; it provides the RMA’s statement of medical‑scientific evidence relevant to the statutory reasonable hypothesis test (s8-s9).

3. Factor lists and timing windows: Section 9 contains an enumerated list of factors. The list is bifurcated:

   • Items 9(1)-9(21) are factors that must exist “before the clinical onset of epilepsy” (for onset) and include traumatic brain injury (TBI), concussion within 20 years, electrical injury to the brain (excluding TMS and ECT), craniotomy/cranioplasty, brain radiotherapy, hypoxic cerebral insult within two months, certain CNS vascular lesions within 20 years, certain infections within 10 years, HIV at onset, septicaemia at onset, intracranial space-occupying lesions, specified dementias, a specified list of medical conditions affecting the brain, obstructive sleep apnoea, tetramine poisoning, diabetes (type 1 or 2), clinically significant depressive disorder at least one year before onset, eclampsia within four weeks, and a quantified alcohol consumption threshold (9(1)-9(21)).
   • Items 9(22)-9(43) mirror many of the same factors but are framed to refer to “clinical worsening of epilepsy” and include additional factors such as moderate to severe alcohol use disorder, inability to use CPAP and inability to obtain appropriate clinical management (9(22)-9(43)).

   Each item typically carries a temporal window that is part of the factor (for example, concussion within 20 years before clinical onset (9(2)); hypoxic cerebral insult within 2 months before clinical onset (9(6))) and some items are time‑neutral (e.g., autoimmune encephalitis “at the time of the clinical onset” (9(8))).

4. Interaction with other SoPs: Where an item in section 9 refers to an injury or disease for which a separate SoP exists, the separate SoP’s factors apply according to that instrument (s11). That mechanism assigns primacy to disease‑specific SoPs for factors that are themselves covered elsewhere, rather than duplicating or redefining them in this instrument.

5. Definitions and evidentiary colour: Schedule 1 supplies definitional content that is operationally significant. It defines terms such as autoimmune encephalitis, hypoxic cerebral insult, intracranial space‑occupying lesion, dementia as specified (a closed list plus “any other type of dementia”), iron overload, and what constitutes “clinically significant” (Schedule 1). The schedule also quantifies alcohol consumption for the purposes of the alcohol thresholds by reference to the Australian standard of 10 grams of alcohol per standard drink (s9 notes and Schedule 1 note). “Clinically significant” expressly does not require that treatment was actually received; the definition turns on whether the condition was sufficient to warrant ongoing management, for example at least monthly visits (Schedule 1, clinically significant).

6. Relationship to service: The instrument requires that any listed factor be related to the person’s relevant service (s10(1)). For the worsening/material contribution factors (9(22)-(43)) there is an additional constraint: those factors apply only where the epilepsy pre‑existed or was contracted before or during service and did not arise out of service (s10(2)). “Relevant service” itself is defined in the Schedule to include operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike and non‑warlike service under the MRCA (Schedule 1, relevant service).

These concepts combine to convert clinical categories and exposures into legally operative predicates used by decision-makers when assessing whether a reasonable hypothesis of service connection exists for epilepsy or death from epilepsy.

The instrument directly affects three groups of principal relevance to claims under the VEA and MRCA:

1. Claimants and veterans (and their representatives): The SoP applies to claims governed by s120A of the VEA and s338 of the MRCA (s5). Any veteran or former member submitting such a claim where epilepsy or death from epilepsy is in issue will be affected because the SoP is the RMA’s current statement of the medical‑scientific factors sufficient to raise a reasonable hypothesis connecting epilepsy to relevant service (s8-s9). Practically, this changes what medical evidence or factual history will be necessary to meet the threshold: for example, an applicant with a recorded moderate to severe traumatic brain injury before clinical onset will satisfy one of the onset factors (9(1)), whereas a claimant without any listed factor will not have a factor from this SoP to support a reasonable hypothesis.

2. Decision‑makers, medical assessors and clinicians: The RMA’s SoP is the technical tool that informs decisions about causation; medical officers who prepare medico‑legal evidence or independent assessments will need to map clinical findings and records to the precise items and temporal windows in section 9 and the Schedule definitions. Insurers and decision-makers use the SoP to standardise the RMA’s view of which medical circumstances are sufficient to raise a reasonable hypothesis; that affects evidentiary enquiries and expert reporting. For example, clinicians must note the instrument’s explicit exclusions (psychogenic seizures, ECT‑related seizures) (s7(2)(c)) and its exclusions for electrical injury (excluding transcranial magnetic stimulation and electroconvulsive therapy) (9(3) note).

3. Departments and administrators administering benefits: The Veterans’ Affairs decision process will use the SoP when applying the statutory reasonable hypothesis test in claims under VEA/MRCA (s3, s5, s8-s9). The instrument therefore shapes initial claim assessments, the scope of further medical examinations, record requests, and whether a matter proceeds to further review avenues under the VEA or MRCA frameworks (the instrument itself does not set review processes, but it is the RMA input to those processes).

Secondary effects include legal practitioners and advisers representing claimants. The SoP alters the evidentiary focus for lawyers preparing causation arguments: whether to rely on listed factors, obtain specialty reports to demonstrate a defined factor within the specified time‑window, or pursue alternate causation theories where the SoP does not list a relevant factor. Where a factor in s9 refers to another injury or disease with its own SoP, practitioners must consult the other SoP because s11 requires applying that separate instrument’s factors “as in force from time to time”.

Geographic and temporal scope are limited to claims covered by the specified statutory provisions (s5) and the SoP commenced on 19 September 2022 (s2). The previous epilepsy SoP (No. 75 of 2013) is repealed (s4), so affected persons whose claims are assessed after commencement will be assessed against the No.84 of 2022 instrument (subject to the operative administrative rules under the VEA/MRCA for retrospective application, which are not set out in the instrument itself).

The instrument also affects clinicians because certain definitional provisions alter evidentiary thresholds: “clinically significant” depressive disorder is defined by a threshold of warranting ongoing management but “does not require that any actual management was received” (Schedule 1). That definition can materially affect evidentiary strategies where treatment records are sparse.

This SoP does not create statutory duties in the sense of sanctionable obligations but it imposes procedural and evidentiary consequences within the VEA/MRCA claims framework. The instrument’s key operational duties and rights, as they flow from its text, are:

• Duty to relate listed factors to relevant service: The instrument requires that the existence of any factor in section 9 must be related to the person’s relevant service (s10(1)). That places an evidentiary duty on the claimant to provide or enable evidence linking the listed factor to a period or event of relevant service. The SoP does not prescribe how that connection is proved; it simply makes the relationship a necessary element.

• Distinction of causal roles and proof burdens: The instrument differentiates onset causation and material contribution/aggravation causation. The onset items (9(1)-9(21)) support a reasonable hypothesis that epilepsy arose in relation to service, when those items existed prior to clinical onset. The material contribution/aggravation items (9(22)-9(43)) apply only where the person’s epilepsy was suffered or contracted before or during, but did not arise out of, the person’s relevant service (s10(2)). Practically that creates a duty on claimants and advisers to identify whether the case is an “arising out of” issue or an aggravation issue, and to marshalled appropriate evidence for the relevant branch.

• Right to rely on RMA’s view of medical‑scientific evidence: For purposes of assessing the “reasonable hypothesis” under the VEA/MRCA, claimants and decision-makers may rely on the RMA’s statement that there is “sound medical‑scientific evidence” indicating epilepsy can be related to relevant service and that the listed factors are sufficient for a reasonable hypothesis (s8). The instrument therefore functions as an evidentiary entitlement: it is the RMA’s authoritative statement for that causation threshold.

• Duty to apply other relevant SoPs where cross‑referenced: Section 11 requires that, where a factor refers to an injury or disease covered by another SoP, the factors in that other SoP apply in accordance with its terms. Decision-makers must therefore identify and apply any applicable separate SoPs and cannot treat the factor in isolation when an alternative SoP governs it.

• Evidentiary requirements implied by definitions: Schedule 1 sets definitional criteria that generate evidentiary effects. For example, “moderate to severe alcohol use disorder” requires meeting at least four specified criteria in a 12-month period. Demonstrating that disorder in evidence is not simply showing high alcohol intake; it requires documentary or clinical evidence mapping to the listed behavioural and clinical criteria (Schedule 1, moderate to severe alcohol use disorder). Similarly, the alcohol consumption thresholds in s9(20) and s9(41) are quantified using the Australian standard of 10 grams per standard drink (s9 notes; Schedule 1).

• No penalties or criminal sanctions: The instrument contains no enforcement provisions imposing civil or criminal penalties; it is a technical statement used internally and externally in the statutory compensation determination process (no penalty provisions appear in the text).

The overall right created is evidential: presence of a listed factor related to relevant service is a RMA‑endorsed route to raising a reasonable hypothesis. The duties are procedural or evidentiary: duty to relate the factor to service, to apply relevant other SoPs, and to meet the definitional thresholds when relying on a listed factor.

The Statement of Principles instrument itself contains no penal provisions, sanctions or administrative fines. It is not framed to punish or to create standalone enforceable duties; instead it is an expert medical‑scientific statement used as a decision tool within the statutory claims infrastructure established by the Veterans’ Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004 (s3-s5). The instrument provides technical criteria that influence administrative determinations, but it does not convert non‑compliance into an offence.

Enforcement in practical terms therefore operates through the benefits and determinations process:

• Administrative effect: Decision-makers assessing claims under the VEA/MRCA will use the SoP as the RMA’s view of medical‑scientific evidence relevant to the statutory “reasonable hypothesis” threshold (s8-s9). The practical enforcement mechanism is denial or acceptance of claims based on whether the claimed facts map to the SoP factors and are related to relevant service. The SoP’s criteria thus act as gatekeeping standards for entitlement determinations, but not as criminal law enforcement.

• Evidentiary consequences: Incorrect or incomplete evidence about whether a listed factor existed or was related to service can result in an adverse administrative determination. The instrument’s precise temporal windows and definitional thresholds (for example, concussion within 20 years (s9(2)), hypoxic insult within 2 months (s9(6)), or alcohol consumption of at least 75 kilograms in 5 years (s9(20) and s9(41), with the calculation metric in Schedule 1)) mean that evidentiary shortfalls are likely to be the main proximate cause of claim rejection, rather than any statutory fine.

• Interaction with other SoPs: Section 11 mandates that where a factor refers to an injury or disease covered by another SoP, the factors in that other instrument apply as in force from time to time. The practical enforcement effect is that decision-makers and claimants must consult the other SoP and demonstrate compliance with its factors. Failure to apply the correct SoP could produce an incorrect administrative outcome subject to internal review or external appeal mechanisms embedded in the VEA/MRCA, though this instrument does not itself create appeal routes or penalties.

• No investigatory powers specified: The instrument does not grant investigatory powers, nor does it authorise adverse measures such as suspension of benefits where a claimant fails to meet a factor. Those powers and potential sanctions (if any) would be found in the VEA or MRCA and associated regulations and administrative practices, not in this SoP text.

In short, enforcement is administrative and evidentiary: the instrument shapes the decision criteria used by Departments and tribunals, but it contains no enforcement provisions, penalty scales or offences of its own.

This SoP is explicitly 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 applies (s5). Its legal interaction is therefore within the VEA/MRCA statutory frameworks and the administrative procedures that implement those Acts. The instrument is not a stand‑alone statute; it is an RMA instrument intended to be used as the RMA’s medical‑scientific guidance for the reasonable hypothesis standard embedded in those Acts.

Specific interactions and consequences disclosed in the instrument include:

• Primacy as RMA expert input: The RMA’s view that the listed factors constitute sound medical-scientific evidence for a reasonable hypothesis (s8) is designed to be used by decision-makers applying the VEA/MRCA causation tests. The SoP supplies the technical causation inputs; the ultimate legal analysis of entitlement remains in the VEA/MRCA decision framework. The instrument does not itself alter other substantive provisions of the VEA or MRCA.

• Application of other SoPs where overlapping: Section 11 provides a specific interaction rule: if a factor in this SoP refers to an injury or disease that has its own SoP under subsection 196B(2) of the VEA, that other SoP’s factors apply according to its terms. This produces a rule of cross‑instruments application: claimants and decision-makers must identify when a factor in this SoP triggers application of another instrument and then apply that instrument’s factors as they stand. The cross‑reference limits duplication and ensures disease‑specific SoPs remain authoritative for the diseases they cover.

• Relationship to definitions in the Schedule: The Schedule 1 - Dictionary provides definitions used throughout the instrument, and those definitions interact with other legal definitions in the VEA/MRCA only to the extent they are invoked in this instrument. For example, the Schedule defines “relevant service” by reference to types of service under the VEA and MRCA (Schedule 1, relevant service). Those statutory categories are themselves defined in those Acts; the SoP therefore relies on the statutory categories to establish whether a factor may be related to “relevant service” (s10(1)).

• Repeal of prior RMA instrument: The 2013 epilepsy SoP is repealed by this instrument (s4). That is an internal interaction within the RMA instrument set: earlier RMA positions are superseded. How the repeal interacts with transitional or ongoing claims is a question that arises at the VEA/MRCA administrative level; the SoP itself does not specify transitional arrangements.

• No express interaction with criminal or civil liability regimes: The instrument does not purport to change criminal liability, negligence law, or workers’ compensation regimes. Its operation is confined to the medical‑scientific evidence for the statutory reasonable hypothesis used in the VEA/MRCA claims processes.

• Evidence and definition interactions: The Schedule’s definitional choices carry legal-interaction effects. For example, “clinically significant” depressive disorder is defined with an evidentiary test that does not require that treatment was actually received (Schedule 1): that interacts with administrative evidentiary practice because absence of treatment records does not, by itself, preclude meeting the SoP’s definition.

Practitioners should therefore treat this SoP as the RMA’s operative medical‑science input for epilepsy in the context of VEA and MRCA claims, carefully mapping the terms and cross‑references (especially s11) to other SoPs and to the statutory definitions and procedures contained in the VEA and MRCA.

The instrument records a narrow amendment history as part of its own text. The key historical facts contained in the instrument are:

• This Statement of Principles is identified as “Epilepsy (Reasonable Hypothesis) (No. 84 of 2022)” and is dated 23 August 2022 (title page and opening lines). It formally commences on 19 September 2022 (s2).

• It is expressly made under subsection 196B(2) of the VEA (s3).

• The instrument repeals the previous Statement of Principles concerning epilepsy No. 75 of 2013 (Federal Register of Legislation No. F2013L01894) (s4). The repeal is complete: the text states the prior instrument “is repealed” (s4), indicating the RMA replaced the earlier SoP in whole.

No other amendments, revocations, or historical iterations are recorded in the instrument itself. There is no schedule of prior amendments or amendments to this instrument provided in the text. The instrument does not include transitional provisions specifying how to treat claims that arose before commencement but are assessed after commencement. The only explicit historical operation documented is the repeal of the 2013 SoP and the commencement date.

Practitioners should note that the RMA usually updates SoPs periodically; here the instrument is the RMA’s 2022 replacement for the 2013 instrument. The instrument does not list any consultation history, explanatory memorandum or second reading speech in its text. It does not indicate whether this SoP will be subject to staged implementation or whether the RMA will publish guidance notes on application. To understand any prior positions or the differences between the 2013 and 2022 instruments, a practitioner would need to compare the texts (the instrument itself only records the repeal).

The Statement of Principles text contains no litigation citations, judicial decisions, or references to cases. It is an administrative instrument (an RMA SoP) and does not include a record of litigation concerning its application. Consequently, within the provided instrument there is no litigation history to report.

Operationally, that means:

• The instrument offers no internal guidance on contested application or examples of judicial treatment of the listed factors. It does not purport to pre-empt judicial review or tribunal consideration; it simply sets out the RMA’s medical‑scientific position as of its commencement (s8-s9).

• Practitioners and advisers who need to understand how courts and tribunals treat this SoP must look beyond the instrument to VEA/MRCA decision‑making bodies and case law. The instrument itself does not record such decisions.

• Because the SoP displaces the 2013 instrument (s4), any previous litigation that focused on the older instrument may or may not be directly relevant; the 2022 instrument contains new definitions, temporal windows and factors that will control future adjudications for claims within the statutory scope. The instrument provides no transitional litigation guidance.

Given the absence of litigation references in the text, the instrument’s practical significance for claims and appeals will be revealed through tribunal determinations and judicial review proceedings that post‑date its commencement. For current legal strategy, practitioners must combine the instrument’s technical content with VEA/MRCA appellate jurisprudence available outside this instrument, while noting the instrument itself gives no list of cases or precedential treatment.

This SoP contains multiple specific drafting features and definitional choices that can catch practitioners and claimants if not handled precisely. The principal “gotchas” to be aware of, grounded in the instrument text, are:

1. Onset versus worsening split with different operative conditions: The instrument separates factors for establishing causation of onset (9(1)-9(21)) and factors for material contribution or aggravation of pre‑existing epilepsy (9(22)-9(43)). Crucially, items 22-43 apply only where the person’s epilepsy was suffered or contracted before or during, but did not arise out of, relevant service (s10(2)). Misclassifying a claim as an onset case when it is an aggravation case (or vice versa) can lead to application of the wrong factors and an adverse outcome.

2. Temporal windows are part of the factor: Several items require specified time limits between exposure/injury and clinical onset or worsening. Examples include concussion within 20 years before clinical onset or worsening (9(2), 9(23)), hypoxic cerebral insult within 2 months (9(6), 9(27)), brain infection within 10 years (9(9), 9(30)), eclampsia within 4 weeks (9(19)), and alcohol consumption thresholds within 5 years (9(20), 9(41)). These temporal limits are hard cut‑offs in the instrument and must be matched by documentary evidence.

3. Some criteria are quantitative and can be surprising: The alcohol thresholds in s9(20) and s9(41) require “consuming at least 75 kilograms of alcohol within the 5 years before the clinical onset/worsening of epilepsy” with the calculation using the Australian standard of 10 grams per standard drink (s9 notes; Schedule 1). That equates arithmetically to 7,500 standard drinks over 5 years (the instrument provides the conversion metric; readers should be careful performing calculations to avoid arithmetic errors). The instrument does not provide any smoothing or allowance for reporting error; claimants must produce evidence sufficient to meet this numerical threshold.

4. Definition of “clinically significant” may be counterintuitive: The Schedule defines “clinically significant” as sufficient to warrant ongoing management which may involve regular visits (for example, at least monthly) to a psychiatrist, counsellor or GP. The Schedule expressly notes that warranting ongoing management “does not require that any actual management was received or given for the condition.” That means absence of clinical records is not fatal if evidence supports that the condition was of the required severity.

5. Cross‑referenced SoPs must be identified and applied: s11 mandates that where a factor in s9 refers to an injury or disease that has its own SoP, the other SoP’s factors govern. Practitioners must therefore identify and apply those other instruments; failing to do so can lead to omission of applicable evidence or misapplication of standards.

6. Narrow exclusions: The definition of epilepsy excludes psychogenic seizures and seizures occurring during electroconvulsive therapy (s7(2)(c)(iii) and (iv)). Similarly, the electrical injury factor excludes transcranial magnetic stimulation and electroconvulsive therapy (9 notes). These express exclusions can defeat claims where the seizure history stems from these excluded causes.

7. Broad but sometimes imprecise terms: Items such as “inability to obtain appropriate clinical management for epilepsy” (9(43)) and “inability to use CPAP ventilation” (9(42)) are not elaborated in the Schedule. That creates evidentiary risk: claimants must document the nature of the inability (e.g., documented system‑wide barriers, refusal by providers, or clinical contraindication). The SoP gives no procedural guidance on what level of proof is required for “inability”.

8. Multiple overlapping factors: A single patient may meet several listed factors, but the instrument requires only one for raising a reasonable hypothesis (s9). Conversely, failure to show any one of them does not preclude other evidence under common law causation approaches; however the SoP itself is the RMA’s statement for the reasonable hypothesis test and does not foreclose other lines of argument under VEA/MRCA statutory processes , that interaction is not elaborated in the instrument and must be navigated in practice.

9. Death‑specific requirement for reflex seizures: For death from epilepsy, item 9(21) requires exposure to a specific sensory stimulus or specific repetitive task resulting in a reflex seizure immediately before death. That is a high proximity evidentiary requirement; it must be supported by contemporaneous facts pointing to an immediate trigger and the Schedule defines reflex seizure, specific repetitive task and specific sensory stimulus (Schedule 1).

10. Repeal of 2013 instrument: The earlier SoP is repealed (s4). Claims assessed after commencement will be assessed against the 2022 instrument; practitioners should not rely on interpretations of the earlier SoP without checking for any substantive differences.

Attending to these precise textual features is necessary to avoid common evidential mistakes and to ensure the decision-maker applies the correct instrument and factors.

For claimants, medical advisers and legal representatives preparing a claim where epilepsy or death from epilepsy is at issue, the following practical steps, grounded in the instrument’s text, will materially improve compliance with the RMA’s evidentiary expectation:

1. Map the clinical timeline to the instrument’s temporal windows: Determine the dates of clinical onset of epilepsy, any clinical worsening, and the dates of each potential factor (TBI, concussion, infection, hypoxic insult, radiotherapy, surgery, etc.). The SoP requires factors to exist within specified windows (for example concussion within 20 years before onset (9(2)); hypoxic cerebral insult within 2 months before onset (9(6))). Where dates are uncertain, assemble contemporaneous records (hospital notes, discharge summaries, imaging reports) to support timing.

2. Establish relation to relevant service: The instrument requires that any factor be “related to the relevant service” rendered by the person (s10(1)). Compile service records, incident reports, deployment logs or provider notes that link the factor to service events. For example, if a TBI occurred on operations, include clinical records that tie the TBI to the operational incident and to the dates of relevant service. The Schedule defines “relevant service” categories (Schedule 1, relevant service).

3. Obtain specialised medico‑legal reports that map to the instrument: Ask treating neurologists, neurosurgeons, infectious disease specialists, psychiatrists and sleep specialists to address the specific instrument items and Schedule definitions. Reports should state whether an item in s9 is present, provide dates, and say whether the item is causally connected to relevant service. For “clinically significant” depressive disorder, reports should explain why the condition was sufficient to warrant ongoing management (Schedule 1, clinically significant), even if no treatment was actually received.

4. For alcohol‑related thresholds, quantify consumption carefully: The SoP’s alcohol consumption thresholds require demonstrating at least 75 kilograms of alcohol over 5 years (s9(20), s9(41)), calculated using the Australian standard of 10 grams alcohol per standard drink (Schedule 1). Practically, that means documenting drinking patterns, AUDIT scores, GP notes, admission notes, or family statements that support the quantity over the relevant period. Remember the instrument’s separate definition of “moderate to severe alcohol use disorder” with its behavioural criteria (Schedule 1), which is a separate route under item 9(40).

5. Identify any cross‑referenced SoPs: If a listed factor is itself an injury or disease covered by another SoP, secure and apply that SoP’s requirements. Section 11 requires the other SoP’s factors to apply to that injury or disease. For example, if a factor refers to a cerebrovascular accident, confirm whether a cerebrovascular SoP exists and ensure the evidence meets that SoP’s factors.

6. Address exclusionary definitions: Check whether the claimant’s seizures fall into the express exclusions (psychogenic seizures, seizures during ECT, spontaneous movements with syncope). If excluded by s7(2)(c) or the electrical injury notes, prepare alternative lines of causation or other medical evidence explaining why the exclusion does not apply.

7. Document inability‑type items with contemporaneous evidence: For items requiring “inability to use CPAP” (9(42)) or “inability to obtain appropriate clinical management for epilepsy” (9(43)), provide objective contemporary evidence, such as sleep service records, CPAP compliance reports, clinical contraindication notes, referral rejection letters, waiting list evidence, or correspondence showing attempts to obtain care. The instrument does not define thresholds for “inability”, so detailed documentary support will be necessary.

8. Demonstrate dementia and specific condition diagnoses by reference to Schedule 1: For dementia and specified medical conditions, use diagnostic reports that tie the patient to the Schedule’s defined forms (Schedule 1, dementia as specified; specified list of medical conditions). For example, documentation confirming a diagnosis of Parkinson’s disease with dementia, or Creutzfeldt‑Jakob disease, will satisfy the “dementia as specified” requirement (Schedule 1).

9. For death claims include cause of death and contribution evidence: The instrument includes death from epilepsy where epilepsy contributed to death via a terminal event (s7(3)). Obtain the death certificate, coronial findings (if any), hospital records and witness statements demonstrating how epilepsy contributed to the terminal event listed in Schedule 1 (pneumonia, respiratory failure, cardiac arrest, circulatory failure or cessation of brain function). For reflex seizure deaths (9(21)), document the immediate sensory stimulus or task and its causal proximity to death.

10. Notes on evidence where treatment was not given: Because “clinically significant” does not require that treatment was actually received (Schedule 1), prepare corroborative evidence , witness statements, contemporaneous diary notes, GP statements , that show the condition’s severity and the need for ongoing management, rather than relying solely on a lack of treatment records.

11. Prepare for cross‑checking with earlier SoP material where relevant: Since the 2013 SoP was repealed (s4), compare older claims or previously prepared material against the 2022 instrument’s factors; update reports and evidence where new temporal limits or definitions differ.

12. Administrative practice considerations: Practitioners should present evidence in a way that maps each fact to the specific clause in s9 and to Schedule definitions. For example, label exhibits and expert paragraphs to correspond with s9(1)-(43) and Schedule entries, to make administrative assessment straightforward.

Following these steps will align the claim preparation with the instrument’s structural requirements and reduce evidentiary risk stemming from timing, definition or cross‑instrument issues.