Statement of Principles concerning fibromuscular dysplasia (Reasonable Hypothesis) (No. 81 of 2025)

The Statement is structured around a small set of core concepts drawn from the instrument text. These concepts govern how the RMA’s medical determination operates in the context of VEA and MRCA claims.

• Statement of Principles and legal basis: The instrument is made under subsection 196B(2) of the VEA (s3). It is the RMA’s formal determination of medical factors that can raise a reasonable hypothesis in claims. The RMA records its view that there is sound medical-scientific evidence connecting the condition to relevant service (s8).

• Fibromuscular dysplasia, defined: For the instrument’s purposes, fibromuscular dysplasia is defined as a “non-atherosclerotic and non‑inflammatory segmental disease of the musculature of arterial walls, leading to stenosis of small and medium-sized arteries” and that either warrants medical treatment or results in specified clinical manifestations in a small or medium artery, commonly renal or carotid (s7(2)). The listed clinical manifestations are partial or complete occlusion, aneurysm, dissection, or ischaemia to an organ (s7(2)(b)(i)-(iv)). The instrument expressly excludes “carotid web” from the meaning of fibromuscular dysplasia (s7(2)(c)). The instrument also notes the ICD‑10‑AM code I77.3 is associated with fibromuscular dysplasia but states the statutory meaning is the definition given in subsection (2) (s7(3)-(4)).

• Death from fibromuscular dysplasia: The instrument treats death from fibromuscular dysplasia as included where the terminal event or condition that led to death was contributed to by the person’s fibromuscular dysplasia (s7(4)). The Schedule defines “terminal event” with examples such as pneumonia, respiratory failure, cardiac arrest, circulatory failure or cessation of brain function (Schedule 1).

• Factors that will raise a reasonable hypothesis: The instrument identifies two discrete factors that, as a minimum, must exist before a reasonable hypothesis can be said to be raised connecting fibromuscular dysplasia or death from it with relevant service: (1) having smoked at least 5 pack‑years before clinical onset or clinical worsening; and (2) inability to obtain appropriate clinical management for fibromuscular dysplasia before clinical worsening (s9). The Schedule gives the definition of one pack‑year and explains how to calculate pack‑years (Schedule 1).

• Relationship to service and “clinical worsening”: The Statement requires that any of the factors in s9 must be related to the person’s relevant service (s10(1)). It also clarifies that the “clinical worsening” aspect of the factors is to be read as applying to material contribution to, or aggravation of, the condition where the disease was suffered or contracted before or during (but did not arise out of) the person’s relevant service (s10(2)). This creates a rule for cases of pre-existing fibromuscular dysplasia that worsens clinically in relation to service.

• Interaction with other Statements of Principles: If a factor in s9 refers to an injury or disease that is covered by another Statement made under subsection 196B(2) of the VEA, the other Statement’s factors apply as they stand (s11). This establishes a mechanism for cross-reference where comorbid or causally related injuries or diseases are covered elsewhere.

These concepts frame the evidentiary threshold at the “reasonable hypothesis” level. The instrument does not elaborate procedural steps for claims lodgement or appeals; it establishes the medical-factual criteria that decision-makers must use within the statutory claims processes to assess causation.

The instrument applies to persons making claims under the VEA or MRCA frameworks to which section 120A of the VEA or section 338 of the MRCA apply (s5). The text identifies the affected groups by reference to those categories of service in the Schedule’s definition of “relevant service” and by the RMA’s purposive language in s8. Concretely, the Statement will be engaged in claims by:

• veterans and former members of the Defence Forces whose claims are lodged under the VEA where section 120A applies (s5); and

• members and former members covered by the MRCA where section 338 of the MRCA applies to a claim (s5).

The Schedule defines “relevant service” to include operational service, peacekeeping service, hazardous service and British nuclear test defence service under the VEA, and warlike and non‑warlike service under the MRCA (Schedule 1). Thus the instrument will affect claimants who assert that fibromuscular dysplasia or death from it is connected to such specified categories of service.

Who pays: The instrument itself does not create payment obligations or specify which agency pays compensation. It operates as medical guidance used to establish whether a causal link can be reasonably hypothesised in a claim processed under the VEA or MRCA. The practical effect for claimants is that the presence or absence of the factors in s9 will influence whether decision‑makers proceed to entitlements modelling under the statutory schemes.

Who decides: The Repatriation Medical Authority makes the Statement (s3). The text also establishes that the existence of the enumerated factors is what must be shown to raise a reasonable hypothesis (s9). The claim decision-maker within the VEA or MRCA framework will rely on this Statement when assessing causation. The instrument does not itself allocate decision-making power for claims or appeals; it provides the RMA’s medical criteria to be applied by the statutory decision-makers referenced in s5.

Medical and clinical stakeholders: Treating clinicians, medical experts engaged by claimants, and medico-legal assessors will be affected because the Statement defines the medical constructs, the required timing of smoking exposure (5 pack‑years before clinical onset or worsening) and the scope of “inability to obtain appropriate clinical management” as causally relevant factors (s9; Schedule 1). The Schedule’s definition of “one pack‑year” and the calculation example provide explicit evidentiary guidance for clinicians to document smoking history.

Administrative stakeholders: The Department or agency responsible for processing VEA and MRCA claims will apply the Statement in decisions. The instrument requires cross-reference to any other Statements when factors refer to other injuries or diseases (s11), which will affect how claims with comorbid conditions are assembled and assessed.

Excluded persons/conditions: The instrument excludes “carotid web” from the definition of fibromuscular dysplasia (s7(2)(c)). Where claimants have carotid web as their pathology, this Statement’s definition will not apply.

This Statement does not create duties in the sense of obligations enforceable by fines or criminal sanctions. Instead it creates medical-factual criteria that operate within the statutory claims frameworks. The key “duties and rights” for participants in the claims process are therefore procedural and evidentiary, as derived from the instrument text.

Rights arising from the Statement

• Right to have a reasonable hypothesis considered: The Statement prescribes the minimum factual factors that must be present for a decision-maker to conclude that a reasonable hypothesis exists linking fibromuscular dysplasia, or death from it, to relevant service. Specifically, at least one of the factors in s9 must exist to raise the reasonable hypothesis (s9). This gives claimants a defined evidentiary pathway: if they can establish one of the factors as related to their relevant service, the reasonable hypothesis threshold is met for causation purposes.

• Right to rely on cross-referenced Statements: Where a factor in s9 refers to an injury or disease covered by another Statement of Principles determined under subsection 196B(2) of the VEA, claimants can rely on that other Statement’s factors as they are in force (s11). This allows claimants with comorbid conditions to use established medical linkages set out in other Statements.

Duties or evidentiary responsibilities implied by the Statement

• Duty to show the factor exists and is related to relevant service: The Statement requires that any factor relied upon must be related to the person’s relevant service (s10(1)). That places on the claimant the evidentiary task of showing temporal and causal connection between the factor (for example, smoking history or inability to obtain clinical management) and the relevant service.

• Duty to demonstrate timing for smoking factor: The smoking threshold in s9 requires evidence that the person “had smoked at least 5 pack‑years before clinical onset or clinical worsening.” The Schedule defines one pack‑year and shows how to compute pack‑years (Schedule 1). That creates a precise evidentiary duty to establish quantity, timing and duration of tobacco use preceding clinical onset or worsening.

• Duty to establish “inability to obtain appropriate clinical management”: The second factor in s9 refers to inability to obtain appropriate clinical management before clinical worsening. The instrument does not define “appropriate clinical management” in detail. Consequently, claimants will need to produce evidence that they were unable to access appropriate care before a clinical deterioration, and that such inability is related to their relevant service under s10(1).

• Duty to establish clinical worsening where disease pre-existed: The Statement provides that the “clinical worsening” aspect of factors applies where the disease was suffered or contracted before or during (but did not arise out of) relevant service, to address material contribution to or aggravation of the disease (s10(2)). This requires claimants with pre-existing fibromuscular dysplasia to show clinical worsening temporally related to service and to fit the instrument’s notion of material contribution or aggravation.

Limits and procedural scope

• The Statement supplies only medical-factual factors; it does not itself specify the procedural rights, appeal paths, or compensation calculation mechanisms which remain governed by the VEA and MRCA statutory provisions. The instrument’s scope is limited to defining the condition, the terminal event for death, and the factors sufficient to raise a reasonable hypothesis (s7-s11).

Key textual references for duties and rights: s3 (authority), s5 (application), s7 (definition and meaning), s9 (factors), s10 (relationship to service), s11 (interaction with other Statements), Schedule 1 (definitions, including pack‑year and terminal event).

The instrument does not prescribe criminal penalties, civil fines, or administrative sanctions. It is a Statement of Principles made under subsection 196B(2) of the VEA and functions as a medical‑evidentiary standard to be applied within the relevant claims frameworks. The text contains no enforcement provisions or penalty clauses.

Practical enforcement mechanism

• Application in decision-making: The operative enforcement mechanism is procedural: the Statement’s factors are used by claim decision-makers under the VEA and MRCA to determine whether a reasonable hypothesis exists connecting fibromuscular dysplasia or death from it to relevant service (s5, s9). Where at least one of the factors in s9 is shown and is related to relevant service (s10(1)), the reasonable hypothesis threshold is met. That, in statutory practice, will influence whether an entitlement claim proceeds to favourable consideration under the relevant Act, but the instrument itself does not set or enforce entitlements.

• Role of the Repatriation Medical Authority: The RMA makes the Statement (s3) and records its view that there is sound medical‑scientific evidence of a link between the condition and relevant service (s8). The RMA’s determination carries statutory weight in claims assessments, but the instrument does not empower the RMA to impose penalties; it provides medical guidance for claims processing.

No inspection, audit or compliance regime in the Statement

• The instrument contains no provisions for audits, record-keeping obligations, or sanctions for false or misleading statements by claimants. The instrument relies on other statutory frameworks to regulate procedure, evidentiary standards, and potential sanctions for fraud or misrepresentation, but those are not referenced or created here.

Evidentiary and administrative checks

• By specifying clear factors and definitions (for example, the pack‑year calculation in Schedule 1), the Statement reduces ambiguity in factual assessment. However, the instrument leaves implementation and evidentiary standards to the statutory decision-making processes under the VEA and MRCA. The Statement does not describe how to verify smoking histories, how to assess inability to obtain appropriate clinical management, or the standard of proof required beyond the ordinary “reasonable hypothesis” threshold referenced in s9. Those procedural and evidentiary enforcement mechanisms sit outside the text of this Statement.

In short, there are no direct penalties or enforcement mechanisms in the Statement itself; the document establishes medical-factual criteria that are enforced indirectly through the claim-assessment processes under the VEA and MRCA by decision-makers who apply this Statement as medical guidance.

The Statement is an instrument made under the VEA statutory power and is intended to operate within that Act and the MRCA. Its interaction with other laws is multipronged, as set out in the text.

Direct statutory integration

• Made under VEA s196B(2): The instrument expressly states it is made under subsection 196B(2) of the VEA (s3). The instrument therefore has the specific statutory role assigned by that provision: to determine medical Statements of Principles used for causation assessments in veterans’ entitlements.

• Application to claims under VEA and MRCA: The instrument applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (s5). That language integrates the Statement into the statutory threshold tests for causation in those provisions. The precise content of s120A and s338 are not reproduced in the instrument, but their invocation identifies the statutory claim categories that will use this Statement.

Interaction with other Statements of Principles

• Cross-reference mechanism: Section 11 creates an explicit interaction rule with other Statements determined under subsection 196B(2) of the VEA. If a factor in s9 refers to an injury or disease covered by another Statement, the factors in that other Statement apply as in force from time to time. This establishes a system of cross-referencing among Statements and provides a legal mechanism for composite causation where multiple conditions are implicated.

Relevance to classification systems

• ICD‑10‑AM reference: The Statement notes that fibromuscular dysplasia attracts ICD‑10‑AM code I77.3 (s7(3)) but clarifies that, for applying the Statement, the definition in s7(2) controls. It further specifies that any reference to an ICD‑10‑AM code is a reference to the 2017 Tenth Edition, effective 1 July 2017 (s7(4)-(5)). This links the instrument to the national morbidity classification, while retaining the statutory definition.

Interaction with compensation and entitlement law

• Medical threshold for “reasonable hypothesis”: The Statement sets the medical facts that will satisfy the threshold of a reasonable hypothesis. That concept operates inside the claims processes created by the VEA and MRCA. The Statement therefore interacts functionally with the statutory decision-making criteria for entitlements but does not itself alter the substantive entitlement rules or compensation calculation mechanisms set out in the VEA or MRCA.

No express interaction with general tort, health, or administrative law

• The instrument contains no express provision about its effect on tort claims, workers compensation schemes, or general administrative law remedies. Any such interactions would depend on how courts and tribunals treat RMA Statements where relied upon in non‑statutory contexts. The instrument itself limits its operation to claims “to which section 120A of the VEA or section 338 of the MRCA applies” (s5) and to the statutory mechanism established by subsection 196B(2).

Temporal interaction with previous Statements

• Repeal of prior Statement: The instrument repeals the prior Statement (No. 79 of 2016) (s4). This creates a temporal interaction whereby the new Statement supersedes the old on commencement. The instrument does not specify transitional arrangements or savings clauses. Practically, decision-makers applying the factors will use the new instrument from its commencement date (s2).

In summary, the Statement is an RMA medical instrument designed to be applied within the statutory frameworks of the VEA and MRCA. It interacts directly with other Statements of Principles through s11 cross-references, aligns to an ICD classification for coding purposes while preserving its own statutory definition, and displaces the prior Statement by repeal. The Statement does not, however, purport to modify entitlement formulas or to create rules outside the VEA/MRCA claims processes.

This instrument contains a concise amendment history within the text. It is a new Statement of Principles designated No. 81 of 2025 and expressly repeals the earlier Statement of Principles concerning fibromuscular dysplasia (Reasonable Hypothesis) (No. 79 of 2016) (Federal Register of Legislation No. F2016L01674) (s4). The new Statement was dated 24 October 2025 (cover page) and commences on 24 November 2025 (s2).

Key dates and actions recorded in the instrument

• Date of instrument: The front matter records the instrument Dated 24 October 2025.

• Commencement: The instrument commences on 24 November 2025 (s2).

• Authority for making the instrument: The Statement is made under subsection 196B(2) of the VEA (s3). That subsection authorises the Repatriation Medical Authority to determine Statements of Principles for particular injuries or diseases for the purposes of claims under the VEA and MRCA. The instrument itself does not record any previous amendments occurring to this particular document other than the full repeal of the earlier No. 79 of 2016 instrument.

Repeal and predecessor

• Repeal of No. 79 of 2016: The prior Statement dealing with fibromuscular dysplasia (No. 79 of 2016) is explicitly repealed by this instrument (s4). The instrument cites the Federal Register of Legislation number for the repealed instrument. No transitional or saving provisions are included in this instrument text.

No in-text amendment clauses

• The instrument contains no clauses that amend other Acts or instruments, other than the repeal described in s4. It does not, for example, amend any provision of the VEA, MRCA, or other Statements. Its effect is to replace the prior Statement with the text now set out.

Implications for claims timing and prior decisions

• The instrument does not itself set out transitional arrangements, retroactivity provisions, or how pending claims started under the earlier Statement should be treated. The text simply states the repeal and the commencement date. Any procedural transition or treatment of claims initiated before commencement would depend on the implementing practices of the decision-making authorities under the VEA/MRCA and is not specified here.

No subsequent amendments recorded in the document

• The instrument does not record any subsequent amendments after commencement because the document as provided is the final form of the instrument making the new Statement and effecting repeal. Any future amendments would require further instruments under the VEA’s subsection 196B(2) process, but none are recorded in this text.

In short, the amendment history contained in the instrument is limited to its enactment date, its commencement date, and the repeal of the specific prior Statement (No. 79 of 2016). The instrument does not provide further transitional detail or amendment lineage beyond those elements.

The instrument does not include or record any litigation history. It contains no mention of court or tribunal decisions, nor does it cite any case law. The text names the Repatriation Medical Authority as the maker and lists the replaced instrument (No. 79 of 2016), but there are no references to judicial consideration, judicial review, or litigation outcomes.

What the instrument records

• Repeal of prior Statement: The only historical legal action the instrument records is the repeal of the earlier Statement (No. 79 of 2016) (s4). That administrative act is not litigation; it is a replacement of one RMA Statement with another.

No judicial findings, appeals, or precedent cited

• The Statement contains no references to litigation, and does not state whether any appeals, reviews or judicial interpretations influenced the drafting. The RMA’s stated view that there is “sound medical‑scientific evidence” (s8) is an administrative assertion, not a judicial finding.

Implications for users who might litigate

• Absence of in‑instrument litigation history means that users cannot rely on any appellate or judicial treatment of this Statement as recorded in the instrument. Any use of the Statement in court or tribunal proceedings will be governed by how decision‑makers apply this Statement within the VEA or MRCA processes and by subsequent judicial consideration external to the Statement. The instrument itself provides no guidance on precedent or prior judicial acceptances of similar Statements.

• Where claimants or decision-makers wish to challenge how this Statement is applied in a particular claim, applicable judicial or merits review avenues under the VEA/MRCA and administrative law would govern that process, but the instrument does not specify those avenues or record any instances where they have been used in relation to this or prior Statements.

No named cases in the instrument

• The text does not name any cases. It does not refer to precedent or to judicial interpretations of fibromuscular dysplasia or of RMA Statements generally. Any litigation history must therefore be sourced from outside the instrument text; the instrument itself contains none.

In sum, the Statement’s text is silent on litigation. It provides the RMA’s medical determination and repeals an earlier Statement, but contains no record of judicial treatment, challenges or precedent within its contents.

This Statement contains a number of specific definitional and evidentiary features that will materially affect claim preparation and assessment. The following points are drawn directly from the instrument text and identify areas that commonly give rise to dispute or require careful attention.

1. Narrow statutory definition vs ICD code: The instrument notes that fibromuscular dysplasia attracts ICD‑10‑AM code I77.3 (s7(3)), but it also explicitly states that, in applying the Statement, the meaning is that given in subsection 7(2) (s7(3)). Practitioners should not assume ICD coding alone suffices; the statutory definition’s elements must be met. The instrument’s definition requires non‑atherosclerotic, non‑inflammatory segmental disease of arterial musculature producing stenosis and specific clinical manifestations, and it expressly excludes carotid web (s7(2)(a)-(c)).

2. Exclusion of carotid web: The exclusion of carotid web from the definition (s7(2)(c)) is categorical. A diagnosis of carotid web will not fall within this Statement. That exclusion must be emphasised in clinical reports used in claims.

3. Low number of enumerated factors: The Statement lists only two factors required to raise a reasonable hypothesis: (a) at least 5 pack‑years of smoking prior to clinical onset or worsening; and (b) inability to obtain appropriate clinical management before clinical worsening (s9). There are no additional environmental, occupational, or service‑specific factors listed. Where claimants wish to rely on other exposures, the instrument provides no direct support.

4. Smoking threshold and timing: The smoking factor requires at least 5 pack‑years before clinical onset or clinical worsening (s9(1)). The Schedule defines “one pack‑year” and provides examples and a calculation method (Schedule 1). Evidence must therefore establish quantity and timing of tobacco use up to the point of clinical onset or clinical worsening, not merely lifetime tobacco exposure.

5. “Before clinical onset or clinical worsening”: Both enumerated factors in s9 are expressed with the temporal qualification “before clinical onset or clinical worsening.” The instrument also treats “clinical worsening” separately when the disease preceded service, clarifying that clinical worsening is the aspect that can be linked to material contribution or aggravation by service (s10(2)). Claimants with pre‑existing disease must therefore have evidence of clinical deterioration temporally connected to service.

6. Undefined “appropriate clinical management”: The second factor uses the phrase “inability to obtain appropriate clinical management for fibromuscular dysplasia before clinical worsening” (s9(2)). The instrument does not define what constitutes “appropriate clinical management.” That vagueness can generate disputes over standard of care, causation and whether the inability was related to relevant service as required by s10(1).

7. Relationship to relevant service required: Section 10 requires that the existence of any factor referred to in s9 “must be related to the relevant service rendered by the person” (s10(1)). This imposes an additional causal or temporal nexus test beyond mere existence of the factor. Evidence must link the factor to the relevant service category described in the Schedule.

8. Clinical worsening in pre-existing disease: The instrument states that the clinical worsening aspect applies to material contribution to or aggravation of fibromuscular dysplasia where the disease was suffered or contracted before or during (but did not arise out of) relevant service (s10(2)). This means that for pre-existing disease, the relevant causal question is whether service materially contributed to or aggravated the condition, manifested as clinical worsening.

9. Cross-reference to other Statements: If a factor in s9 refers to an injury or disease covered by another Statement, that other Statement’s factors apply (s11). Practitioners must check whether the smoking or management factors should be read alongside other Statements for comorbid conditions. Failing to do so can miss applicable supportive medical factors in related Statements.

10. Death definition tied to terminal event contribution: Death from fibromuscular dysplasia is included only where death resulted from a terminal event or condition that was contributed to by the person’s fibromuscular dysplasia (s7(4)). The Schedule’s definition of terminal event gives examples but the causal phrase “contributed to” will require evidence of contribution, not necessarily sole causation.

11. Repeal without transitional detail: The instrument repeals the previous Statement (s4) and commences on 24 November 2025 (s2). No transitional or saving provisions are included. Practitioners should ensure they apply the new Statement from commencement and verify whether administrative practice provides guidance on claims spanning the repeal.

12. No procedural or evidentiary detail on verification: The Statement sets factual criteria but does not prescribe methods for verifying pack‑years, establishing inability to obtain care, or measuring clinical worsening. Expect disputes about what documentary or expert testimony suffices.

These “gotchas” arise directly from the text. They identify precise points where claim drafting, medical reporting and administrative decision-making will need careful treatment to ensure the Statement’s tests are satisfied and properly linked to relevant service.

Compliance, in the context of this Statement, means assembling and presenting the medical and factual evidence necessary for a claims decision-maker under the VEA or MRCA to find that a reasonable hypothesis exists. The instrument supplies the criteria; compliance is the task of meeting those criteria with admissible evidence and linking the evidence to relevant service as required by s10(1).

Evidence to establish the enumerated factors (s9)

• Smoking history: To meet s9(1), obtain contemporaneous medical records, patient histories, social history notes or other documentary evidence that quantify cigarette or tobacco consumption. Use the Schedule’s definition of one pack‑year and the provided calculation method (Schedule 1) when compiling a pack‑year figure. Ensure records demonstrate that at least 5 pack‑years of smoking occurred before the clinical onset or before clinical worsening. Explicitly state dates, average daily cigarette equivalents, and the method used for conversion where non‑cigarette tobacco products are involved, utilising the Schedule guidance that equates 1 gram of tobacco to one cigarette and 7,300 grams per year to 1 pack‑year equivalent where needed.

• Clinical onset or clinical worsening timing: Define precisely when clinical onset occurred, and, if relevant, when clinical worsening occurred. Provide clinical notes, imaging dates, treatment initiation dates, and specialist opinions that fix those dates. The smoking evidence must be shown to predate those dates.

• Inability to obtain appropriate clinical management: For s9(2), document attempts to obtain care, referrals, wait times, correspondence showing refusal or lack of available specialists, distances to specialist centres, or administrative barriers attributable to service circumstances. Because “appropriate clinical management” is not defined in the instrument, medical expert reports should set out accepted standards of care for fibromuscular dysplasia, show that the person did not receive that standard, and connect the inability to receive such care to the claimant’s relevant service circumstances.

Linking factors to relevant service (s10(1))

• Establish nexus to relevant service: For any factor relied upon, prepare evidence that links the factor to the claimant’s relevant service as defined in the Schedule (operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, warlike or non‑warlike MRCA service). For example, where inability to obtain care is alleged to be due to posting in an overseas location during relevant service, provide service records, posting dates and contemporaneous evidence of lack of local specialist services.

• Clinical worsening and pre-existing disease (s10(2)): For claimants with pre-existing fibromuscular dysplasia, provide baseline clinical status before service, then document the clinical worsening after or during service with objective measures (imaging reports, blood pressure records, surgical interventions, or documented aneurysm, dissection or ischaemia). Expert opinion should address whether the degree and timing of worsening meet a standard of material contribution or aggravation.

Cross-references and comorbidity (s11)

• Check other Statements: If any factor implicates another injury or disease covered by an RMA Statement, obtain and apply the factors from that other Statement as they stand, and obtain expert opinion that addresses the interaction. The instrument requires the other Statement’s factors to apply according to their terms (s11).

Medical expert evidence

• Use experts to translate clinical findings into the statutory criteria: Because the Statement is a medical standard, independent specialist reports from vascular surgeons, neurologists, nephrologists or other relevant specialists should address: whether the clinical manifestations meet the s7(2) definition (stenosis, occlusion, aneurysm, dissection, ischaemia); timing of onset and worsening; the contribution of smoking history or lack of management; and the causal link to relevant service. Experts should reference the Schedule definition of pack‑years when discussing smoking.

Documentation and record-keeping

• Corroborating documentary evidence: Keep full contemporaneous service records, medical records during and after service, referral and appointment records, imaging and intervention reports, and any correspondence evidencing attempts to obtain care. That evidence will underpin claims that factors existed and were related to relevant service.

Death claims

• For claims alleging death from fibromuscular dysplasia, prepare cause of death documentation and expert opinion showing that the terminal event that led to death was contributed to by fibromuscular dysplasia, in line with s7(4) and the Schedule’s definition of terminal event.

Timing and repeal considerations

• Apply new Statement from commencement date: The instrument repeals the prior Statement (s4) and commences 24 November 2025 (s2). Apply the No. 81 of 2025 factors to claims that fall under the relevant statutory sections after commencement. For claims that straddle the repeal date, obtain administrative guidance from decision-making bodies as to transition, since the instrument includes no transitional provisions.

Practical drafting checklist

• Confirm diagnosis fits s7(2) definition and is not carotid web (s7(2)(c)).
• Quantify and document pack‑years using Schedule 1 methodology and show the exposure was before clinical onset/worsening (s9(1); Schedule 1).
• Document inability to obtain appropriate clinical management with evidence and expert opinion linking lack of management to clinical worsening (s9(2)).
• Demonstrate that the factor relied upon is related to the relevant service category (s10(1)).
• For pre-existing disease, document baseline status and objective evidence of clinical worsening; obtain expert opinion on material contribution/aggravation (s10(2)).
• Check and incorporate any applicable factors from other RMA Statements if cross-referenced by s9 (s11).

By following the instrument’s precise definitions and temporal requirements and by assembling contemporaneous medical and service evidence with targeted expert analysis, claimants and representatives will meet the practical demands of the Statement’s reasonable hypothesis test as set out in the instrument.