Statement of Principles concerning Gaucher disease (Reasonable Hypothesis) (No. 37 of 2023)

The primary substantive concepts in the instrument are: the medical definition of Gaucher disease, the “reasonable hypothesis” evidentiary threshold, the enumerated factor(s) that must exist to raise that hypothesis, the temporal and causal relationship to relevant service, and interaction with other Statements of Principles. Each concept is articulated in a discrete provision, and the instrument is narrowly tailored in scope to those concepts.

Definition of the disease: Gaucher disease is defined in clinical-genetic terms as a genetic disorder of sphingolipid metabolism involving deficiency of the lysosomal enzyme glucocerebrosidase, with consequent accumulation of glucocerebroside and other glycolipids in macrophages located in organs including spleen, liver, bone marrow and bone. The instrument adds clinical manifestations in an explanatory note, naming splenomegaly, hepatomegaly, thrombocytopaenia and anaemia (s 7(2) and notes). The instrument also treats death from Gaucher disease as including death from a terminal event or condition to which the disease contributed, with “terminal event” defined in Schedule 1 (s 7(3); Schedule 1).

Evidentiary threshold: The Statement operates on the Repatriation Medical Authority’s “reasonable hypothesis” framework. Section 9 states that at least one of the listed factors must exist before it can be said that a reasonable hypothesis has been raised connecting Gaucher disease, or death from Gaucher disease, with circumstances of a person’s relevant service. The instrument lists only one factor: inability to obtain appropriate clinical management for Gaucher disease (s 9(1)). The instrument thereby sets a low-number, specific-factor model: the presence of that factor, properly linked to service, is sufficient to meet the “reasonable hypothesis” threshold.

Relationship to service and temporal limitations: Section 10 requires that any factor in s 9 be related to the person’s relevant service, where “relevant service” is defined comprehensively in Schedule 1 to include operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike and non-warlike service under the MRCA (Schedule 1). Significantly, subsection 10(2) limits the application of s 9(1) (inability to obtain appropriate clinical management) to cases of material contribution to, or aggravation of, Gaucher disease where the disease was suffered or contracted before or during, but did not arise out of, the person’s relevant service. Thus the instrument differentiates between disease arising out of service and pre-existing disease aggravated by service; the single factor operates only in the latter scenario (s 10(2)).

Interaction with other Statements of Principles: Section 11 provides a mechanism for cross-application where a factor in this Statement refers to an injury or disease already covered by a different Statement of Principles. In that event the factors in the other Statement apply “in accordance with the terms of that Statement of Principles as in force from time to time” (s 11). This creates a layered approach where overlapping pathologies or causation mechanisms can be resolved by resort to other Statements.

Authority and evidentiary claim: Section 3 records the statutory authority under s 196B(2) of the VEA for the RMA to make this instrument, and section 8 sets out the RMA’s view that sound medical-scientific evidence indicates that Gaucher disease and death from Gaucher disease can be related to relevant service. The instrument itself does not specify the underlying studies or data; it records the RMA’s view as the basis for the Statement (s 8).

Legal effect and scope: The instrument is expressly stated to apply to claims to which s 120A of the VEA or s 338 of the MRCA apply (s 5). It repeals the prior Statement from 2015 (s 4). The Schedule contains definitional content, including a definition of terminal event and the list of forms of relevant service (Schedule 1). The instrument therefore functions as a binding Statement of Principles for the statutory compensation framework; its concepts determine the medical-causative connections necessary to raise a reasonable hypothesis in claims covered by the cited statutory provisions.

The instrument affects a defined set of actors and interests within the veterans’ compensation ecosystem. Primary affected persons are veterans and members of forces who make claims under the VEA or MRCA in respect of Gaucher disease or death from Gaucher disease, where those claims fall within the statutory thresholds cited by the instrument (s 5). The instrument’s Schedule defines “relevant service” to include operational, peacekeeping, hazardous service, British nuclear test defence service under the VEA, and warlike and non-warlike service under the MRCA (Schedule 1). Therefore serving personnel and veterans whose service falls within those categories may be affected when lodging claims involving Gaucher disease.

Decision-makers and adjudicators are affected indirectly because the Statement provides a determinative medical-causation criterion to be used when deciding whether a reasonable hypothesis exists that connects Gaucher disease or related death to relevant service (s 9). The instrument is made by the Repatriation Medical Authority under s 196B(2) of the VEA (s 3). While the instrument does not itself identify the administrative decision-maker who applies the Statement to a particular claim, it is a binding Statement of Principles within the VEA/MRCA scheme and therefore will be applied in the statutory claims process for the sections identified in s 5.

Medical practitioners, treating specialists, and forensic/independent medical examiners are affected because evidence of the factor listed in section 9 , inability to obtain appropriate clinical management for Gaucher disease , will need to be articulated, documented and assessed. The instrument defines Gaucher disease in medical terms and lists clinical manifestations (s 7(2) and notes), and it defines “terminal event” relevant to death claims (Schedule 1). Those medical descriptions set the clinical frame for medico-legal evidence that clinicians will be asked to provide.

Legal representatives, advocates, and claims preparers are affected in preparing claims because the instrument sets out what must be shown to raise a reasonable hypothesis. They will need to assemble evidence addressing the factor in s 9, and the link to service required by s 10. The repeal of the 2015 Statement (s 4) may change how existing or future claims are framed, so practitioners with ongoing matters need to check whether prior evidence aligns with the new criteria.

Family members and estates may be affected where a claim involves death from Gaucher disease, because the instrument treats death as including deaths from a terminal event contributed to by Gaucher disease (s 7(3)) and defines terminal event in the Schedule. This affects the causal nexus required for death claims.

Other related interest groups may be affected through s 11, which cross-links this Statement to other Statements of Principles where factors overlap. If a factor in this Statement refers to an injury or disease covered by another Statement, the provisions of that other Statement apply as in force (s 11). This affects claimants whose causation arguments involve co-morbid or related conditions covered by different Statements.

Finally, the instrument affects the administrative process by replacing the prior Statement of Principles (s 4). That repeal means prior determinations relying on the 2015 Statement may need reassessment for new claims, and practitioners should note the commencement date (s 2) to determine which Statement applies to any given claim under s 120A of the VEA or s 338 of the MRCA (s 5).

The Statement sets legal criteria rather than prescriptive administrative duties or statutory rights within its own text; nevertheless it creates operational duties for claimants and decision-makers by defining what must be established to raise a reasonable hypothesis and by restricting the circumstances in which the listed factor applies.

Duty to establish the factor(s): For a claimant seeking to raise a reasonable hypothesis that Gaucher disease or death from Gaucher disease is related to relevant service, the claimant must establish at least one of the factors listed in section 9. The Statement lists a single factor: inability to obtain appropriate clinical management for Gaucher disease (s 9(1)). The instrument therefore imposes an evidentiary duty on claimants to demonstrate the existence of that factor as linked to service.

Duty to show relationship to relevant service: The instrument requires that any factor asserted under s 9 be related to the person’s relevant service (s 10(1)). “Relevant service” is defined in Schedule 1 and includes specified categories under the VEA and MRCA (Schedule 1). Practically this means claimants must provide evidence not only of the factor itself, but of an event, circumstance or condition during the period of relevant service that gives the required nexus between that factor and the service rendered.

Temporal and causation limitation on application: The single listed factor applies only to material contribution to, or aggravation of, Gaucher disease where the disease was suffered or contracted before or during, but did not arise out of, the person’s relevant service (s 10(2)). This is a substantive limit on the scope of the factor: it does not, in this instrument, operate to connect to disease that arose out of service. The right to have a reasonable hypothesis raised therefore depends upon satisfying that temporal/causation condition.

Interaction duty where other Statements are engaged: Section 11 creates a duty to observe the terms of other Statements of Principles when factors in this Statement refer to injury or disease governed by those Statements. If the factor in this Statement refers to an injury or disease for which another Statement has been determined, then the factors in that other Statement apply as in force (s 11). This means practitioners and decision-makers must consult cross-referenced Statements and apply their terms where relevant.

Right to rely on the Statement for claims under specified statutory sections: The Statement is explicitly applicable to claims to which s 120A of the VEA or s 338 of the MRCA apply (s 5). Individuals with claims within those statutory provisions therefore have the right to rely on this Statement of Principles as the RMA’s authoritative articulation of the medical-causation criteria for Gaucher disease in the statutory claim process.

Administrative right to updated criteria: The instrument repeals the prior 2015 Statement and replaces it with the 2023 Statement (s 4). Where claims are assessed after the commencement date (s 2), the new Statement will be the relevant criterion. Claimants and representatives have the right to expect that decisions made under the cited VEA or MRCA provisions will apply the Statement current at the time the claim is assessed.

No penal provisions in the instrument: The Statement itself does not create penalties, sanctions or new administrative offences. Its function is to prescribe medical-causation criteria under the statutory claims regime; any duties it imposes are evidentiary and procedural within the claims process rather than criminal or civil liabilities created by this instrument.

Duty to apply the RMA’s view: The RMA records that it is of the view there is sound medical-scientific evidence that Gaucher disease and death from it can be related to relevant service (s 8). Decision-makers applying the Statement will therefore do so against the RMA’s stated view that a medical-scientific basis exists for the linkage. The instrument does not list the specific studies or findings; it records RMA’s view as the basis for the Statement (s 8).

The instrument is a Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986 and is not framed as an enforcement or penalty instrument. It does not specify criminal or civil penalties, fines, compliance notices, or enforcement mechanisms. The legal effect of the Statement is procedural and evidentiary within the statutory claims framework: it sets the medical-causation criteria required to raise a reasonable hypothesis that Gaucher disease or death from Gaucher disease is related to relevant service (s 9). As such, its operational “enforcement” is exercised through administrative determinations under the VEA and MRCA rather than through sanctions imposed by the Statement itself.

What the instrument does not do: The Statement does not create offences, provide for inspections, grant regulatory powers or specify sanctions for non-compliance. It also does not itself grant or deny compensation or other entitlements; rather, it prescribes the medical criteria that must be met under the statutory claims processes to establish a causal link to service. Any enforcement or penalties relevant to making false claims, providing false evidence, or other misconduct would arise under the broader statutory scheme or general law, not from this Statement itself; no such provisions are set out in the text of the instrument.

How the Statement is operationally applied in adjudication: The practical enforcement of the Statement occurs when decision-makers applying the VEA or MRCA consider whether the facts and evidence in a claim meet the RMA’s criteria for raising a reasonable hypothesis. If the adjudicator finds that the required factor(s) and service connection are not established, the reasonable hypothesis test will not be met and the claim may be unsuccessful on that basis. Conversely, if the factor(s) and service nexus are established as required by the Statement, a reasonable hypothesis will have been raised and the claims process continues in accordance with the VEA or MRCA. The instrument itself does not prescribe the decision-making steps, evidentiary weight or standard of proof beyond the requirement that at least one factor must exist and be related to the person’s relevant service (s 9; s 10).

No internal penalty provisions nor enforcement bodies named: The instrument identifies the Repatriation Medical Authority as the body making the Statement under s 196B(2) (s 3), but it does not confer enforcement powers on the RMA beyond its statutory authority to make Statements of Principles. The instrument therefore functions as binding medical guidance for the statutory claims regime rather than as an enforcement tool with penal mechanisms.

The Statement is explicitly made under the VEA by reference to subsection 196B(2) (s 3) and applies to claims to which s 120A of the VEA or s 338 of the MRCA apply (s 5). It therefore operates within, and in support of, the statutory claims framework established by the VEA and MRCA. The Statement’s legal function is to provide the Repatriation Medical Authority’s authoritative medical-causation criteria for Gaucher disease in the context of those Acts.

Direct statutory interactions: The Statement’s applicability is expressly tied to particular provisions in the VEA and the MRCA (s 5). It is not a freestanding law of general application; its operative effect is within the VEA/MRCA claims processes. The instrument was made under s 196B(2) of the VEA; that subsection is the statutory gateway that empowers the RMA to determine Statements of Principles to be used in assessing claims. Because of that statutory anchoring, the Statement functions as a determinative medical instrument for decisions under the named statutory sections.

Interaction with other Statements of Principles: Section 11 provides a direct mechanism for interaction between this Statement and other Statements of Principles made under subsection 196B(2) of the VEA. If a factor listed in this Statement refers to an injury or disease for which another Statement has been determined, then the factors in that other Statement apply in accordance with its terms as in force from time to time (s 11). This creates an interlocking system where overlapping medical or causal issues are resolved by applying the relevant Statements in combination.

Effect on claims and adjudication: The Statement alters the evidentiary and legal landscape for claims under s 120A of the VEA and s 338 of the MRCA. Decision-makers charged with adjudicating those claims will apply this Statement as the RMA’s medical guidance on causation for Gaucher disease. The instrument’s repeal of the 2015 Statement (s 4) means that the 2023 Statement replaces the previous medical criteria, which will affect how claims are assessed from the commencement date (s 2). Practitioners should identify which Statement was in force at the time relevant to a claim to determine which medical criteria apply.

Definitions and cross-references: The Schedule provides definitions (s 6; Schedule 1) that align the Statement’s terminology with the statutory scheme. “Relevant service” is defined broadly in Schedule 1 to include multiple service categories under the VEA and MRCA, which clarifies the statutory contexts in which the Statement is operative. The Schedule also defines “terminal event,” which is relevant for death claims (Schedule 1). Because the Statement’s terms are procedural inputs into the VEA/MRCA claims process, these definitions directly affect the statutory interaction and the scope of claims that can invoke the Statement’s criteria.

Limits of the instrument’s interaction with other law: The Statement itself is limited to the medical-causation criteria and does not purport to alter other substantive rights, obligations or procedural rules in the VEA or MRCA beyond providing the RMA’s medical view. The instrument does not create new statutory rights or penalties; its interaction with other laws is through the role it plays in claims determination under the cited statutory provisions.

This instrument replaces a prior Statement. Section 4 expressly repeals the Statement of Principles concerning Gaucher’s disease No. 27 of 2015 (Federal Register of Legislation No. F2014L01843) (s 4). The instrument is dated 24 April 2023 and commences on 23 May 2023 (s 2). Those are the only amendments or historical entries recorded within the text of the instrument itself.

What is recorded in the instrument:

• Date of determination by the Repatriation Medical Authority: 24 April 2023 (front matter).
• Commencement date: 23 May 2023 (s 2).
• Repeal of prior Statement No. 27 of 2015: s 4.

No other amendment entries or history are recorded in the text provided. The instrument does not include a history of prior amendments to the 2015 Statement or any intermediate amendments; it simply states the 2015 Statement is repealed and replaced by this 2023 Statement (s 4). The Schedule and definitions are set out as part of this instrument and are the operative definitions following commencement (s 6; Schedule 1).

Practical implication of the amendment: For claims and matters assessed after the commencement date, the 2023 Statement will be the operative RMA Statement for Gaucher disease where the claim falls within the statutory sections identified in s 5. Practitioners, claimants and decision-makers should therefore treat the 2015 Statement as no longer in force from the commencement date (s 2; s 4).

Absence of recorded transitional provisions in the instrument: The text provided does not include transitional provisions specifying how matters pending under the 2015 Statement are to be handled. The instrument simply repeals the prior Statement (s 4) and records a commencement date (s 2). Where transitional treatment is required, those provisions, if they exist, would need to be located in the underlying VEA/MRCA administrative rules or decision-making guidelines; the instrument itself does not set them out.

No recorded subsequent amendments: The instrument contains no entries indicating subsequent amendments since commencement. Any later revisions would appear as separate instruments or amending instruments and are not present in the text provided.

The instrument’s text contains no references to litigation, court decisions, or judicial consideration of the Statement. It does not list any cases, appeals or legal challenges to the 2023 Statement of Principles within the document itself. The instrument records the Repatriation Medical Authority’s view that sound medical-scientific evidence supports a relationship between Gaucher disease and relevant service (s 8), but it does not identify any judicial commentary or litigation history concerning that view.

Because the instrument is a Statement of Principles under subsection 196B(2) of the VEA, its role in decisions may, in practice, be the subject of administrative review or judicial review when applied to particular claims; however, no such matters are recorded or referenced in the instrument’s text. The Schedule and sections simply set out the Statement’s content, commencement and repeal of the prior Statement (s 2; s 4).

Where claimants or decision-makers engage the courts over the application of the Statement, any litigation history would appear in court records, published judgments or administrative review databases. Those records are not part of this instrument and are not cited in the text provided. The Statement itself does not recite past litigation, nor does it include a list of authorities that were relied upon in forming the RMA’s view under s 8.

In short, the instrument contains no internal litigation history. Parties seeking to know whether the Statement has been subject to judicial scrutiny will need to consult external judicial databases and decisions, noting that the instrument itself makes no mention of such litigation.

This instrument is concise and narrowly framed, and its drafting produces several specific points that practitioners and claimants should note because they materially affect how a claim can be made and assessed.

Single listed factor: The Statement requires at least one factor from section 9 to exist to raise a reasonable hypothesis (s 9). The instrument lists only one factor: inability to obtain appropriate clinical management for Gaucher disease (s 9(1)). The narrowness of the factor list is consequential. A claimant whose causation argument relies on other potential mechanistic factors will not meet the Statement’s threshold unless those factors are encompassed by s 9(1) or are referred in other Statements applied via s 11. Practitioners should therefore pay close attention to whether the factual matrix of a claim fits within the single listed factor.

Undefined key term risk: The phrase “inability to obtain appropriate clinical management for Gaucher disease” is not defined in the instrument and does not appear in the Schedule as a defined term (compare s 9(1) with s 6 and Schedule 1). That lack of definition creates potential uncertainty about what precisely must be demonstrated , for example, whether it requires proof of service-related barriers to access, lack of availability of specific therapies, administrative denial of care, distance to treatment, or other causes. This will be a focal point in evidence and adjudication because the RMA’s stated “sound medical-scientific evidence” basis (s 8) does not specify access criteria or thresholds.

Temporal constraint on application: Subsection 10(2) restricts the application of s 9(1) to cases of material contribution to, or aggravation of, Gaucher disease where the person’s Gaucher disease was suffered or contracted before or during, but did not arise out of, the person’s relevant service (s 10(2)). Therefore the s 9(1) factor is not a route for claims where Gaucher disease is alleged to have arisen out of service. Practitioners must identify and prove the timing of onset relative to service and the nature of causation (material contribution/aggravation versus arising out of service), because the Statement distinguishes those scenarios expressly.

Death claims require contribution to a terminal event: For death claims, section 7(3) includes deaths from a terminal event or condition that was contributed to by the person’s Gaucher disease (s 7(3)). The Schedule defines “terminal event” to include specific proximate causes such as pneumonia and respiratory failure (Schedule 1). A death caused by a terminal event must be shown to have been contributed to by Gaucher disease. This requires causal-link evidence that the disease materially contributed to the terminal event; mere coexistence of Gaucher disease and a terminal event will not automatically satisfy the Statement unless contribution can be demonstrated.

Cross-Statement complexity: Where a factor in this Statement refers to an injury or disease covered by another Statement, subsection 11(2) makes the factors in that other Statement applicable (s 11). That can produce complexity in multi-morbidity claims. Practitioners must identify all implicated Statements and apply them “as in force from time to time,” which means staying current with other Statements that may change.

Commencement and repeal timing: The instrument repeals the 2015 Statement (s 4) and commences on 23 May 2023 (s 2). Parties must take care to apply the correct Statement in relation to the date and status of the claim. The instrument does not contain transitional provisions addressing claims lodged before commencement; the absence of transitional text in the instrument itself is a point to check in the broader statutory/regulatory framework.

No penalty or enforcement clarifications: Because the Statement is evidentiary rather than penal, it does not specify standards for assessing documentary proof, weight of evidence, or procedural steps for adjudicators. That leaves scope for administrative discretion in how decision-makers interpret and apply the single listed factor and the undefined phrase within s 9(1).

Limited medical descriptors: While s 7(2) defines Gaucher disease in biochemical and pathological terms and lists possible clinical manifestations, the instrument is not a clinical guideline on management. It does not state which clinical management strategies are “appropriate,” nor does it specify the standard of care or what constitutes denial or inability to obtain care. That gap places emphasis on medico-legal evidence and expert opinion in claims.

No litigation history recorded: The instrument contains no litigation history to guide interpretation of ambiguous terms in practice. Where ambiguity arises, administrative review or judicial interpretation may be necessary, but the instrument provides no guidance on that point.

In summary, the key “gotchas” are the single, undefined factor requirement; the temporal limitation that the factor applies only where the disease predated or coincided with service but did not arise out of it; the necessity to demonstrate contribution to a terminal event for death claims; and the need to consult other Statements where overlap exists. These drafting features will shape evidence collection, legal argument and decision-maker discretion.

For claimants, legal representatives, treating practitioners and decision-makers, compliance with this Statement means assembling and presenting evidence that squarely meets the requirements articulated in the instrument. The Statement sets a particular evidentiary structure: show the presence of at least one factor in s 9 and demonstrate that the factor is related to the person’s relevant service as required by s 10. The following practical steps are grounded in the instrument’s provisions and the logical implications of those provisions.

1. Identify applicability to statutory claim sections

• Confirm that the claim falls within the statutory provisions specified by the instrument: claims to which s 120A of the VEA or s 338 of the MRCA apply (s 5). If the claim does not fall within those sections, this Statement is not the operative RMA Statement.

2. Establish the medical diagnosis as defined

• Ensure the medical diagnosis of Gaucher disease is recorded in terms consistent with the instrument’s definition: a genetic disorder of sphingolipid metabolism involving deficiency of glucocerebrosidase with accumulation in macrophages and the clinical manifestations listed in the notes (s 7(2) and notes). Medical records should identify relevant signs such as splenomegaly, hepatomegaly, thrombocytopaenia or anaemia where present.

3. Prove the required factor(s)

• The sole factor listed is inability to obtain appropriate clinical management for Gaucher disease (s 9(1)). Because the instrument does not define “inability to obtain appropriate clinical management,” compliance requires detailed evidence addressing what is meant in the particular factual context. Practically this can include contemporaneous clinical notes, referrals, waitlist documentation, correspondence showing access barriers, evidence of unavailability of specific therapies during or after service, or reasons why care was not obtained. Records should link the inability to obtain management to events or circumstances that occurred in the period of relevant service if that is the asserted nexus.

4. Prove relationship to relevant service

• Section 10 requires that the factor in s 9 be related to the person’s relevant service (s 10(1)). Schedule 1 defines relevant service categories. Compliance therefore requires assembling service records, posting/deployment records, medical records from service, and any documentation of medical treatment availability or denial during the relevant service period. Evidence should detail how the inability to obtain appropriate clinical management was caused by or connected to the person’s relevant service.

5. Respect the temporal limitation in s 10(2)

• Demonstrate that, where s 9(1) is relied upon, the person’s Gaucher disease was suffered or contracted before or during, but did not arise out of, relevant service (s 10(2)). That requires precise timing of onset and an argument that service materially contributed to or aggravated a pre-existing condition, rather than being the originating cause. Medical chronology and expert opinion supporting timing and aggravation may be necessary.

6. For death claims, show contribution to terminal event

• If the claim is for death from Gaucher disease, show that Gaucher disease contributed to the terminal event that caused death, as the instrument includes deaths from a terminal event or condition contributed to by Gaucher disease (s 7(3)). The Schedule defines terminal event and provides examples (Schedule 1). Medical records, death certificates, autopsy reports, and expert medical evidence should be marshalled to show contribution rather than mere presence.

7. Account for cross-referenced Statements

• If the factual issue refers to an injury or disease that is covered by another Statement of Principles, identify the relevant Statement and apply its factors in accordance with s 11. This requires checking the current version of any related Statements “as in force from time to time” and ensuring compliance with their terms.

8. Anticipate and address the undefined phrase

• Given the absence of a statutory definition for “appropriate clinical management,” anticipate that decision-makers will examine the reasonableness and contemporaneous nature of clinical options and access. Provide documentary evidence of what management was available, what was considered “appropriate” in the treating clinicians’ view, and why it could not be obtained. Expert medicolegal reports that contextualise standard treatments and access conditions in the relevant period may be necessary.

9. Prepare a clear medico-legal narrative

• Claims should present a chronological narrative supported by primary documents: service records, clinical notes, referral letters, correspondence, test results, treatment availability/denials, and expert opinion linking the inability to obtain appropriate management to service and, where relevant, to material contribution or aggravation of disease.

10. Monitor Statement currency

• The instrument applies “as in force from time to time” to cross-referenced Statements (s 11). Practitioners should verify that they are using the current RMA Statement(s) for Gaucher disease and any related conditions at the time of claim lodgement and decision.

11. Consider administrative procedures outside the Statement

• Although the Statement itself does not set procedural steps for appeals or reviews, claimants should ensure they follow statutory claim submission requirements under the VEA/MRCA provisions cited by s 5 and preserve evidence and records in case administrative review or further medical assessment is required.

In short, compliance requires focused documentation tying the single listed factor , inability to obtain appropriate clinical management , to the person’s relevant service, and, where applicable, demonstrating that the disease predated or coincided with service and was materially aggravated rather than arising out of service. Practitioners should be alive to the vagueness of “appropriate clinical management” and prepare evidence that addresses likely adjudicator questions about what was appropriate and why it could not be obtained.