Statement of Principles concerning gastro-oesophageal reflux disease (Reasonable Hypothesis) (No. 61 of 2021)

This Statement of Principles is built around a small set of legal and clinical concepts that determine how entitlement claims are assessed.

Reasonable hypothesis: The instrument is framed to operationalise the "reasonable hypothesis" standard used in determinants of service connection. Section 9 provides the factual triggers that, singly or in combination, constitute the minimum evidence required to form a reasonable hypothesis that GERD or death from GERD is related to relevant service. The Authority states the basis for selecting those factors in s 8, but the instrument does not itself define "reasonable hypothesis"; it prescribes the factual prerequisites to satisfy that standard.

Clinical onset and clinical worsening: The instrument distinguishes between clinical onset and clinical worsening of GERD. Many factors are drafted to apply either at the time of clinical onset (see ss 9(1)-9(10)) or at the time of clinical worsening (see ss 9(11)-9(24)). The distinction matters because s 10(2) makes the factors in subsections 9(11)-9(24) applicable only to material contribution to, or aggravation of, GERD where the disease was suffered or contracted before or during (but did not arise out of) the person's relevant service. The instrument therefore differentiates between causation (disease arising out of service) and material contribution/aggravation (service affecting a pre‑existing condition).

Defined clinical condition: Section 7(2) gives a statutory definition of gastro‑oesophageal reflux disease for purposes of this instrument. It is defined as a chronic retrograde flow of gastro‑duodenal contents into the oesophagus, larynx or pharynx that results either in symptoms sufficient to warrant regular medical treatment, or histological evidence of oesophageal inflammation. It explicitly includes reflux oesophagitis and reflux with oesophageal ulceration, and expressly excludes Barrett’s oesophagus and several other specific oesophageal conditions (s 7(2)(b)-(c)).

Quantitative thresholds and time windows: Multiple factors are framed in quantitative terms:

• Smoking: at least 1.5 pack‑years, commencement at least five years before clinical onset or worsening, and if cessation occurred before onset/worsening the onset/worsening must have been within one year of cessation (ss 9(3), 9(13); Schedule 1 for pack‑year definition).
• Alcohol: at least 300 grams of alcohol per week for at least the year before onset or worsening (ss 9(4), 9(14); Schedule 1 clarifies 10 grams per standard drink for calculation).
• Surgery: surgery to the oesophageal hiatus or involving the fundus/body of the stomach within six months before onset or worsening (ss 9(5), 9(15)).
• Occupational exposure (wind instrument): average at least 25 hours per week, cumulative period at least one year, and onset/worsening required to occur within 30 days of cessation where practice ceased prior to onset/worsening (ss 9(10), 9(20)).
• BMI/waist circumference criteria for overweight/obesity at the time of onset or worsening (ss 9(2), 9(12); Schedule 1 provides BMI formula and waist circumference thresholds).

Lists and cross‑references: The Schedule provides the detailed lists referenced in s 9:

• Specified List 1 of drugs (relevant to onset; s 9(6));
• Specified List 2 of drugs (relevant to worsening; s 9(22));
• Specified list of diseases (s 9(7), 9(17));
• Specified list of disorders of mental health (s 9(21)). Section 11 provides that if a factor in s 9 refers to an injury or disease covered by another Statement of Principles determined under s 196B(2) of the VEA, then the factors in that other Statement of Principles apply in accordance with their terms.

Death and terminal events: The instrument extends to "death from gastro‑oesophageal reflux disease" defined as death from a terminal event or condition that was contributed to by the person's GERD (s 7(5)). Schedule 1 enumerates examples of terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). This creates a mechanism by which GERD may be connected to a later terminal event for the purposes of an entitlement claim.

Administrative evidentiary purpose: Overall the instrument is an administrative tool that constrains and standardises the medical evidence required in the administrative assessment of claims that GERD is connected to relevant service. It supplies objective and semi‑objective thresholds (BMI formula, pack‑years, alcohol grams) and lists (drugs, diseases) to guide decision makers in applying the reasonable hypothesis standard.

The instrument identifies who is in scope explicitly. It applies to persons making claims to which s 120A of the VEA or s 338 of the MRCA apply (s 5). In language used elsewhere in the instrument, it is clear the primary group affected are:

• veterans and members of the Forces to whom the VEA applies (references to VEA in s 8 and Schedule 1);
• members of Peacekeeping Forces (s 8);
• members under the MRCA (s 8 and s 5).

By design, the instrument is intended to be used in the administrative processing of claims for those categories. That means claimants (veterans and members of relevant Forces) who are alleging that GERD or death from GERD is related to their relevant service are directly affected. It also affects clinical practitioners, medical specialists and medico‑legal reporters who prepare evidence in support of those claims because the instrument defines the medical and factual elements they must address (for example, histological evidence, dates of onset, surgical history, drug exposure, BMI and waist circumference calculations, smoking pack‑year calculations, alcohol consumption quantification).

Administratively, the Repatriation Medical Authority (RMA) is the decision‑maker that made the instrument (s 3). The instrument will be used by the bodies and officers who determine VEA and MRCA claims; the instrument does not itself name those decision bodies, but by operation of s 5 it is invoked within the VEA/MRCA claim processes.

Other affected groups include:

• dependants or estates in claims concerning death from GERD, because s 7(5) extends coverage to death from terminal events contributed to by GERD;
• claim advisers, lawyers and advocates who must marshal evidence meeting the thresholds set out (for example, demonstrating pack‑years and timing, surgery within six months, or specified drug exposure);
• clinicians required to demonstrate timing of clinical onset or worsening, and to link clinical events to service (s 10 requires factors to be related to relevant service).

Indirectly, the instrument affects stakeholders in compensation administration , record‑keepers of service exposures, surgical records, prescriptions, and occupational histories , because claim success will depend on access to such records. It also affects any supplier of medico‑legal opinions who must interpret the Schedule and sections 7-11 when preparing causation evidence.

The instrument does not create criminal or civil liabilities and does not impose duties outside the claim determination context. Its effects are evidentiary and administrative, shaping which claimants can raise a reasonable hypothesis of service connection and the evidence needed to do so.

This Statement of Principles is an evidentiary instrument rather than a statute that imposes direct legal duties on third parties. Nonetheless it creates binding administrative rules that give rise to practical duties for claimants and decision makers within the VEA and MRCA systems.

Duties on decision makers and assessors:

• Apply the instrument in relevant claims. The instrument is made under s 196B(2) VEA (s 3) and applies to claims to which s 120A VEA or s 338 MRCA apply (s 5). Decision‑makers must therefore assess whether at least one of the factors in s 9 exists and whether that factor is related to the person’s relevant service (s 10(1)).
• Respect the defined clinical meaning of GERD. When assessing whether the condition claimed falls within the instrument, assessors must use the instrument’s definition in s 7(2) rather than a bare ICD‑10‑AM code, even though the instrument notes the ICD code (s 7(3)-(4)).

Duties for claimants and their advisers (practical evidential duties):

• Establish clinical onset or clinical worsening dates and link one or more factors in s 9 to those dates.
• Demonstrate that any factor relied upon is related to relevant service (s 10(1)). For factors in subsections 9(11)-9(24), show that the claimed factor materially contributed to, or aggravated, pre‑existing GERD where the condition was suffered or contracted before or during (but did not arise out of) relevant service (s 10(2)).
• Where the factor references another Statement of Principles (s 11), ensure evidence is compliant with the terms of that other Statement of Principles as in force.

Rights implicated:

• The instrument supports a claim‑processing right: claimants have the right to rely on the presence of one or more of the specified factors as satisfying the reasonable hypothesis threshold for causation. If the factual elements set out in s 9 are met and related to service, that is the specified minimum required to raise the legal standard.
• Right to have the instrument applied in determining claims within its scope. Where the VEA/MRCA claim process invokes a Statement of Principles, claimants are entitled to have that instrument’s factors assessed against their medical and service records.

Operational constraints and limits of rights/duties:

• The instrument does not oblige any third‑party (for example, a hospital or practitioner) to produce records, but claimants will practically need clinical and service documentation to meet the instrument’s thresholds.
• The instrument does not itself grant compensation; it provides the medical link element required as part of the broader statutory entitlement framework under the VEA/MRCA.

Specific duties implicit in the Schedule:

• Calculation of BMI and pack‑years must follow the Schedule definitions where these measurements are material to a factor. For example, "being overweight or obese" is defined by BMI ≥ 25 or waist circumference thresholds (Schedule 1), and "one pack‑year" is defined and exemplified (Schedule 1).

In sum, the primary legal effect is to direct how medical causation is evidenced in VEA/MRCA claim determinations: decision makers are required to test claims against the s 9 factors and Schedule definitions; claimants and their advisers have the duty to assemble evidence that matches those prescribed factors and timings.

The Statement of Principles itself contains no criminal or civil penalty provisions, and it does not create enforcement powers beyond its administrative use in determining claims under the VEA and MRCA. The instrument is an administrative standard made under s 196B(2) of the VEA (s 3) and applied to claims falling within s 120A of the VEA or s 338 of the MRCA (s 5). Its enforcement is therefore procedural: it governs what evidence is necessary to establish a reasonable hypothesis of service‑connection in those administrative claim processes.

How enforcement operates in practice:

• Administrative effect: The instrument is intended to be applied by the relevant statutory decision makers , those charged with administering the VEA and MRCA , when assessing causation in claims involving GERD or death from GERD. The instrument sets the evidentiary triggers (s 9) and the standard for relating those triggers to relevant service (s 10). If a claimant cannot demonstrate one or more of the factors, decision makers will likely find that a reasonable hypothesis has not been raised and may refuse entitlement on that ground. The instrument therefore has the effect of limiting or enabling administrative decisions on entitlement.
• Repeal and replacement: The 2013 Statement is expressly repealed (s 4). Decisions made after the commencement date will be judged against this instrument where it applies. This is an enforcement mechanism by substitution: claims previously adjudicated under the 2013 Statement may be differently assessed under the 2021 Statement.

Absence of direct sanctions:

• No fines, imprisonment, or administrative penalties are established by this instrument. It does not confer power to impose sanctions on medical practitioners or claimants for incorrect or incomplete evidence. The instrument is not an enforcement code; it is a standard for decision making.

Potential indirect sanctions via claim outcomes:

• The practical "sanction" is denial of entitlement if the claimant cannot raise the reasonable hypothesis using the instrument’s factors or show the factor(s) were related to service. That effect is administrative and consequential rather than punitive.

Limitations on enforcement information in the instrument:

• The Statement does not state which agency or office will apply it in day‑to‑day claims management. It also does not state appeal routes or the procedural consequences of adverse findings. Those are matters of the underlying VEA/MRCA schemes, not of the Statement itself.

In short, enforcement is achieved by changing the evidentiary baseline used in administrative determinations under the VEA/MRCA. The instrument does not contain separate penalty provisions, enforcement officers, or criminal sanctions.

The instrument operates within and interacts with the VEA and MRCA statutory frameworks and with other Statements of Principles made under the VEA. The text sets out the statutory authority and cross‑references that determine how it is used.

Statutory authority and application:

• The Authority made the instrument under subsection 196B(2) of the VEA (s 3). That subsection is the statutory source of the Authority’s power to determine Statements of Principles. The instrument applies to claims to which s 120A of the VEA or s 338 of the MRCA applies (s 5). Therefore its operation is limited to the claim processes and entitlement provisions found in those Acts. The instrument does not operate outside the VEA/MRCA claim framework.

Interaction with other Statements of Principles:

• Section 11 creates a direct interaction rule: if a factor in s 9 refers to an injury or disease for which another Statement of Principles has been determined under s 196B(2), then the factors in that other Statement of Principles "apply in accordance with the terms of that Statement of Principles as in force from time to time." Practically, this means that where s 9 cites a condition that is itself governed by another Statement (for example, a specified connective tissue disease), assessors must apply that other Statement’s factors and terms when evaluating the cross‑referenced condition. The instrument therefore interlocks with the wider body of Statements of Principles and permits cross‑application rather than inconsistent or duplicative assessment.

Diagnostic coding and clinical classifications:

• Section 7(3)-(4) references the ICD‑10‑AM code K21 for GERD and explicitly states that the instrument uses the definition given in s 7(2) when applying the Statement. The instrument therefore interacts with internationally and nationally used diagnostic classification systems, but it retains its own statutory definition for legal purposes. The instrument also notes the copyright owner of the ICD‑10‑AM code (Independent Hospital Pricing Authority). Users should therefore be aware of the instrument’s definitional primacy and the separate licensing/copyright status of clinical classification publications.

Overlap with other statutory provisions:

• Because the instrument applies to claims under s 120A VEA and s 338 MRCA, it will operate alongside other causation and entitlement provisions in those Acts. For example, the instrument’s evidence will need to be assessed in the context of the statutory entitlement criteria, limitation rules, and any other procedural provisions of the VEA and MRCA. The Statement itself does not displace statutory requirements of those Acts; it complements them by specifying the medical evidence necessary to raise a reasonable hypothesis.

Implications for death claims:

• Section 7(5) expands the instrument to include death from GERD where a terminal event or condition was contributed to by the person’s GERD. Schedule 1 lists examples of terminal events. This means the instrument may interact with death‑related provisions in the VEA/MRCA framework, including dependency and survivorship entitlement provisions, where those exist.

No direct interaction with non‑VEA/MRCA statutes:

• The instrument does not purport to amend or affect non‑VEA/MRCA statutes directly. Its scope is claims covered by the referenced sections of those Acts. Any interplay with broader administrative law (judicial review, natural justice obligations) will arise from the operation of the VEA/MRCA decision processes and administrative law, not from the instrument itself.

In summary, the instrument is a component of the VEA/MRCA administrative machinery. It must be read together with those Acts and with any other Statements of Principles that the instrument references. Its definitional choices and cross‑references determine how medical causation is assessed within that statutory framework.

This Statement of Principles No. 61 of 2021 records a clear and limited amendment history within the instrument itself.

New instrument and commencement:

• The instrument is described in s 1 as "The Statement of Principles concerning gastro‑oesophageal reflux disease (Reasonable Hypothesis) (No. 61 of 2021)." It is dated 21 May 2021 (page header) and s 2 states it commences on 21 June 2021. The commencement gap gives a one month lead time between the signing/dated instrument and operational commencement.

Repeal of the prior Statement:

• Section 4 expressly repeals "The Statement of Principles concerning gastro‑oesophageal reflux disease No. 65 of 2013 (Federal Register of Legislation No. F2013L01653)" that had been made under subsection 196B(2) of the VEA. The repeal indicates a policy update or factual revision from the 2013 approach to the 2021 approach and means that from 21 June 2021 onward, the 2013 Statement ceases to operate for claims within the instrument’s scope.

Absence of other amendments or transitional provisions:

• The instrument contains no further amendment history, no savings or transitional clauses, and no express instructions as to application to claims in progress at commencement. It also contains no revision notes, amendment dates post‑commencement, or schedules of prior amendments other than the repeal. Practitioners should therefore note that the only historic change recorded in the document is repeal of the 2013 Statement and replacement with this 2021 Statement at the dates provided.

Schedule updates and revisions:

• The instrument includes a Schedule (Schedule 1 , Dictionary) which provides definitions and lists used in s 9. The instrument does not indicate any planned staged rollouts, nor does it include delegation of power to amend the Schedule. Any subsequent amendments to the Schedule would therefore be the subject of new instruments published under the Authority’s s 196B(2) power. The instrument does not itself authorise alteration of the lists by administrative regulation or delegated instrument beyond that power.

Practical consequence of repeal:

• Repeal of the earlier Statement may change the evidentiary thresholds for claimants who previously relied on the 2013 Statement. Any claim decisions made after the 2021 commencement will be assessed under the 2021 Statement. The instrument does not record whether previous claim decisions will be revisited; that is a matter for the claim administrators under the VEA/MRCA.

Documentation and public record:

• The instrument refers to the replaced instrument by Federal Register number for identification (F2013L01653). Users seeking the older text should retrieve it by that identifier. The current instrument itself includes the date, instrument number and the seal statement indicating it was affixed at the direction of the Authority Chairperson.

In short, the amendment history recorded in the document is limited to the creation of this instrument (No. 61 of 2021), its commencement date, and the repeal of the 2013 Statement (No. 65 of 2013). Practitioners should check the Federal Register of Legislation for any further instruments amending this Statement after the commencement date.

The instrument itself contains no litigation history and does not identify any court or tribunal decisions. It does not cite judicial authority, nor does it refer to any past or pending litigation. The only internal references are to the VEA and MRCA provisions that confer power to make Statements of Principles (s 3, s 5).

What the absence of litigation history means for practitioners:

• There are no cases named in the Statement for precedent or construction, and therefore the instrument must be applied on its text and the legal framework in which it operates. Practitioners should not rely on the instrument to reflect any judicial interpretation because none is cited.
• If juridical challenges have been brought against this (or prior) Statements of Principles, they are not recorded here. Anyone wishing to know whether the 2013 Statement or its replacement has been subject to judicial review or litigation should consult court or tribunal databases, administrative law records, or other public law sources outside this instrument.

Potential legal avenues not mentioned:

• The Statement does not state routes of appeal or review because those are set out in the VEA and MRCA frameworks and in general administrative law. The instrument does not modify or expand judicial review rights. It also does not indicate whether the RMA’s decisions or the way the instrument is applied have been or can be the subject of merits review or judicial review; those matters must be resolved by reference to the relevant statutory appeal bodies and administrative law principles.

Practical recommendation for readers:

• Given the absence of litigation history within the instrument, practitioners relying on this Statement for case preparation or advocacy should undertake independent legal research to determine whether subsequent case law discusses the application or validity of this or other Statements of Principles. Those search steps are outside the instrument’s text and thus not reflected here.

In sum, the Statement contains no litigation history; it must be applied according to its terms and within the appeal and review mechanisms of the underlying VEA and MRCA systems, with any relevant case law to be sought externally.

The instrument contains numerous specific drafting features and thresholds that can be pitfalls for claimants, advisers and medico‑legal reporters if they are not addressed precisely.

Clinical definition controls over ICD code: Although s 7(3) notes that GERD attracts ICD‑10‑AM code K21, s 7(2) establishes the instrument’s own clinical definition and exclusions. Practitioners should not rely solely on an ICD code in a medical report; the report must address the s 7(2) statutory definition and note explicitly whether the condition falls within the definition and is not excluded (for example Barrett’s oesophagus is expressly excluded by s 7(2)(c)).

Timing windows are strict and varied:

• Smoking cessation rule: ss 9(3) and 9(13) require that if smoking ceased before clinical onset/worsening, the onset/worsening must have occurred within one year of cessation. Claims citing prior smoking will therefore need exact cessation dates and pack‑year calculations per Schedule 1; vague histories will not suffice.
• Smoking commencement rule: smoking must have commenced at least five years before onset/worsening (ss 9(3), 9(13)). Without confirmatory records or consistent self‑reporting, proving the 5‑year lead can be difficult.
• Alcohol consumption threshold: ss 9(4), 9(14) require at least 300 grams of alcohol per week for at least the one year before onset/worsening. Schedule 1 clarifies the calculation base (10 g per standard drink). This is a high threshold that requires documented consumption patterns rather than general heavy drinking assertions.
• Surgery window: ss 9(5), 9(15) apply only where surgery to the oesophageal hiatus or involving the fundus/body of the stomach occurred within six months before onset or worsening. Clinicians must identify the date and type of surgery and correlate it carefully with onset/worsening dates.
• Wind instrument practice: ss 9(10), 9(20) require average practice of at least 25 hours/week and cumulative period of at least one year, with a 30‑day post‑cessation onset/worsening rule. Occupational records, payslips, gig/touring schedules, or contemporaneous logs are necessary to document these thresholds.

Different drug lists for onset vs worsening and additional causality tests:

• Specified List 1 (Schedule 1) pertains to factors at clinical onset (s 9(6)) while Specified List 2 pertains to clinical worsening (s 9(22)). Practitioners must treat these as distinct categories and ensure medication histories are mapped accurately to the relevant date (onset vs worsening).
• For orally taken drugs associated with worsening, s 9(23) requires either (a) improvement of GERD within three months of stopping or tapering the drug, or (b) clinical worsening on rechallenge with the same drug, and the drug must have been taken at the time of worsening. This imposes a causal test beyond mere exposure; clinical response to dechallenge or rechallenge is required.

Differing causal standards for certain factors (s 10(2)):

• Factors in ss 9(11)-9(24) apply only to material contribution to, or aggravation of, GERD where the disease was suffered or contracted before or during (but did not arise out of) relevant service. In practice this means that if the disease arose out of the service (i.e. is alleged to have originated because of service), those factors may not be used to establish causation under the material contribution standard. Practitioners must correctly classify claims as arising out of service or as aggravation of pre‑existing disease to apply the correct subsection.
• This introduces a potential evidential trap: improper framing of the medical history (for example, asserting onset occurred after service when records suggest pre‑existing disease) can render certain factors inapplicable or misapplied.

"Being overweight or obese" measurement specifics:

• Schedule 1 defines overweight or obese as either BMI ≥ 25 or waist circumference > 80 cm for women or > 94 cm for men. The BMI definition requires using the W/H2 formula in Schedule 1. Practitioners must ensure weight and height measurements are contemporaneous with the relevant time (onset/worsening) and that the calculation is documented; retrospective or approximate measurements could be challenged.

Exclusions and specificity of diagnoses:

• s 7(2)(c) explicitly excludes Barrett's oesophagus, non‑reflux oesophagitis, non‑reflux oesophageal ulceration, traumatic oesophageal perforation or tear, and oesophageal varices. Claims based on those diagnoses are outside this Statement. Conflation or mislabelling by clinicians will be an issue: a clinician report must state clearly if the diagnosis is GERD as defined or one of the excluded entities.

"Death from GERD" linkage: s 7(5) includes death from a terminal event or condition that was contributed to by the person’s GERD. Schedule 1 lists examples of terminal events, but causation at death often involves multiple comorbidities. Practitioners must prepare evidence showing contribution rather than sole causation.

Cross‑referenced Statements:

• Section 11 requires application of other Statements of Principles where s 9 refers to an injury/disease already covered by another Statement. Failure to consult or correctly apply the cross‑referenced Statement can result in an incomplete causation analysis.

Broad catch‑all factor , inability to obtain appropriate clinical management (s 9(24)):

• This factor is framed broadly and lacks quantitative thresholds. It may be interpreted variably and could create evidentiary uncertainty; claimants relying on it should provide contemporaneous documentation of attempts to obtain care, referrals, waiting lists, or correspondence showing denial or lack of services.

Record quality needed:

• The Statement’s precision in thresholds places a premium on contemporaneous, well‑documented clinical records, service records, surgical records, prescription records, occupational logs and where relevant, dechallenge/rechallenge documentation. Absent those records, reliance on the Statement’s factors will be difficult.

In short, the "gotchas" are procedural and evidential: the Statement sets precise thresholds and distinct causal regimes. Failure to provide accurate dates, measurements, or to understand which factors apply to onset versus worsening, or to pre‑existing versus service‑originated disease, will materially affect the outcome of a claim.

For lawyers, clinicians, claims officers and advisers preparing or assessing claims under this Statement, compliance requires aligning evidence to the instrument’s textual thresholds and the Schedule definitions. The practical compliance steps below map directly to the statutory text (primarily s 7-11 and Schedule 1).

1. Confirm instrument applicability

• Verify the claim falls within s 5: it must be a claim to which s 120A of the VEA or s 338 of the MRCA applies. If so, the Statement is the relevant evidentiary instrument for GERD causation.

2. Establish the diagnosis against s 7(2)

• Obtain medical records that demonstrate GERD as defined in s 7(2): chronic retrograde flow resulting in either (i) symptoms sufficient to warrant regular medical treatment, or (ii) histological evidence of oesophageal inflammation.
• Explicitly address exclusions in s 7(2)(c). If a report notes Barrett’s oesophagus, non‑reflux oesophagitis, or other excluded conditions, the claim must not be framed as GERD under this Statement.

3. Identify whether the issue is clinical onset or clinical worsening

• Determine the relevant event: initial clinical onset or a clinically documented worsening. Different factors apply to onset (ss 9(1)-9(10)) and to worsening (ss 9(11)-9(24)), and s 10(2) sets a distinct causal regime for factors in 9(11)-9(24).

4. For the chosen event, map available evidence to at least one factor in s 9

• Hiatus hernia: imaging, endoscopy, or surgical reports demonstrating hiatus hernia present at the time of onset/worsening (ss 9(1), 9(11)).
• Overweight/obese: contemporaneous weight and height to calculate BMI using W/H2 (Schedule 1), or waist circumference measurements meeting the thresholds (>80 cm women, >94 cm men) (ss 9(2), 9(12)).
• Smoking: construct a pack‑year history per Schedule 1; demonstrate smoking commenced at least five years before onset/worsening; if smoking ceased before onset/worsening show onset/worsening occurred within one year of cessation (ss 9(3), 9(13)).
• Alcohol: quantify consumption in grams per week (Schedule 1 sets 10 g per standard drink); show average ≥300 g/week for at least the year before onset/worsening (ss 9(4), 9(14)).
• Surgery: obtain operative and hospital records showing surgery to the oesophageal hiatus or involving the fundus/body of the stomach within six months prior to onset/worsening (ss 9(5), 9(15)).
• Drugs: list all medications, their routes and dates. For onset rely on Specified List 1 (s 9(6)); for worsening rely on Specified List 2 (s 9(22)). For oral drugs alleged to cause worsening, document dechallenge (improvement within three months of stopping/tapering) or rechallenge (worsening on re‑exposure) per s 9(23).
• Specified diseases and disorders: obtain diagnostic evidence for any disease in the specified lists (ss 9(7), 9(17), 9(21); Schedule 1 lists the relevant conditions).
• Pregnancy and diabetes: establish timing , pregnancy at time of onset/worsening (ss 9(8), 9(18)); diabetes mellitus diagnosis at time of onset/worsening (ss 9(9), 9(19)).
• Wind instrument practice: obtain employment, performance or practice logs to meet 25 hours/week average and one year cumulative requirement and document cessation dates if relevant (ss 9(10), 9(20)).
• Inability to obtain appropriate clinical management: assemble contemporaneous correspondence, referral refusals, waiting‑list evidence, or appointment cancellations to substantiate claims under s 9(24).

5. Demonstrate relationship to relevant service (s 10)

• For any factor relied upon, prepare evidence showing how the factor is related to the person’s relevant service (s 10(1)). This can include service records, tasking logs, deployment medical records, or expert opinion that links the factor temporally or causally to service.
• For factors in ss 9(11)-9(24), ensure the evidence is framed as material contribution to or aggravation of pre‑existing disease , and document that the disease was suffered or contracted before or during (but did not arise out of) relevant service (s 10(2)). This requires careful chronological reconstruction.

6. If a factor references another Statement of Principles (s 11)

• Identify the other Statement referenced. Obtain and comply with its terms "as in force from time to time" when preparing and assessing evidence for the cross‑referenced injury or disease.

7. Use Schedule technical definitions precisely

• BMI calculation: use W/H2 (Schedule 1). Record units and contemporaneous measurements.
• Pack‑years: follow Schedule 1 definition and examples; provide calculations (number of cigarettes/day divided by 20, multiplied by years smoked).
• Alcohol grams: convert standard drinks to grams using the Schedule 1 standard (10 g per standard drink).
• Drug lists: rely on the exact nomenclature in Schedule 1 to avoid misclassification.

8. Prepare medico‑legal opinion addressing the instrument directly

• Expert reports should state whether the factor(s) in s 9 are present, the basis for that conclusion (documentary and clinical), and whether the factor(s) were related to relevant service (s 10).
• For dechallenge/rechallenge evidence (s 9(23)), ensure the clinician documents temporal response to cessation and re‑exposure where possible.

9. Document contemporaneous dates and records

• Many factors require precise dates (onset, cessation, commencement of smoking, surgery dates, medication start/stop). Gather GP records, hospital records, pharmacy dispensing histories, surgical notes and service records to create a reliable chronological record.

10. If claiming death from GERD, document contribution to terminal event

• For death claims under s 7(5), obtain cause of death documentation, terminal event evidence (for example, pneumonia diagnosis), and expert opinion linking GERD as a contributor to the terminal event. Show how the terminal event falls within the Schedule 1 definition and the causal contribution of GERD.

11. Address excluded conditions explicitly

• If medical records show conditions that are excluded under s 7(2)(c), explain why the claimant’s condition is nonetheless GERD as defined, or consider alternative claims for the excluded condition under any other applicable Statement or legal pathway.

12. Keep cross‑referenced Statements and statutory provisions in view

• Because s 11 requires cross‑application where s 9 refers to conditions governed by other Statements, obtain those Statements and ensure evidence meets their criteria.

13. Record management for incomplete historic data

• If contemporaneous measurements (e.g. waist circumference, exact alcohol intake) are absent, compile proxy evidence (weight charts, GP notes, contemporaneous accounts). Where gaps cannot be closed, advise clients of evidentiary risk given the instrument’s precise thresholds.

14. Note operational dates

• This Statement commenced on 21 June 2021 (s 2) and replaces the 2013 Statement (s 4). For claims spanning the repeal/commencement window, identify which instrument governs the claim in accordance with VEA/MRCA procedures.

Summary checklist (practical):

• Confirm instrument applicability (s 5).
• Obtain complete medical history and treatment records addressing s 7(2) definition.
• Produce precise dates for clinical onset/worsening, smoking start/stop, alcohol pattern, surgeries, medication timing.
• Calculate BMI and pack‑years per Schedule 1.
• Collect operative, prescription, practice logs for wind instrument musicians, and relevant disease diagnostic reports.
• Secure expert medico‑legal reports directly addressing s 9 factors and s 10 relationship to service.
• If relying on s 9(23) drug causation, ensure dechallenge/rechallenge evidence is documented.
• If relying on s 9(24) inability to obtain clinical management, assemble contemporaneous administrative correspondence and appointment history.

Adhering to these steps aligns evidentiary preparation with the instrument’s explicit thresholds and reduces the risk that a claim will fail on the basis that none of the s 9 factors have been demonstrated or related to service under s 10.