Statement of Principles concerning haemorrhoids (Balance of Probabilities) (No. 20 of 2026)

The instrument organises around three core legal-medical concepts: the clinical meaning of haemorrhoids, the factors that may link haemorrhoids to relevant service, and the temporal and causal constraints on how those factors operate in claims.

Clinical meaning. Haemorrhoids is defined functionally as inflammation, bleeding, thrombosis, prolapse or symptomatic enlargement of the haemorrhoidal cushions (section 7(2)(a)). The instrument clarifies that this statutory meaning controls even though haemorrhoids also attract particular ICD‑10‑AM codes (section 7(3) and note at subsection (4)). The text explicitly excludes anorectal varices (section 7(2)(b)).

Death linked to haemorrhoids. Death from haemorrhoids is included where death results from a terminal event or condition that was contributed to by the person’s haemorrhoids (section 7(5)). The Schedule defines "terminal event" and lists example terminal events such as pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (Schedule 1, terminal event).

Factors that, if established, permit a finding of service connection. Section 9 enumerates alternative factors; at least one must be present for a positive connection. The factors are largely factual and time-bound. They include pregnancy within six weeks before clinical onset or clinical worsening (s 9(1)); straining at stool due to constipation or diarrhoea within two weeks before clinical onset or worsening (s 9(2)); spinal cord injury at the time of clinical onset or worsening (s 9(3)); chewing khat at least weekly for at least three months before onset or worsening (s 9(4)); inability to consume an average daily intake of 20 grams of fibre in food for specified periods before onset or worsening (s 9(5)-(6)); taking anticoagulants, antiplatelet agents, or non‑steroidal anti‑inflammatory drugs within 30 days before haemorrhoidal bleeding for clinical worsening (s 9(7)); and inability to obtain appropriate clinical management for haemorrhoids before clinical worsening (s 9(8)). The Schedule defines anticoagulants, antiplatelet agents, and fibre in food in operational terms (Schedule 1).

Service relation and pre‑existing disease. Section 10(1) requires that any of the section 9 factors "must be related to the relevant service rendered by the person." Section 10(2) imposes a further constraint for the "clinical worsening" aspect of factors in section 9: those clinical‑worsening factors apply only to material contribution to, or aggravation of, haemorrhoids where the person’s haemorrhoids were suffered or contracted before or during (but did not arise out of) the person’s relevant service. Thus the SoP differentiates onset during service that arises out of service from pre-existing or service‑concurrent conditions that may be aggravated by factors.

Cross-references to other SoPs. Section 11 provides a mechanism where a factor in this SoP refers to an injury or disease covered by another Statement of Principles made under subsection 196B(3) of the VEA. If that is the case, the other SoP applies in accordance with its terms as in force from time to time.

Standard of proof. The SoP and its title adopt the "balance of probabilities" standard. Section 8 states the RMA’s view that, on the sound medical‑scientific evidence available, it is more probable than not that a relationship can exist between haemorrhoids and relevant service. The RMA therefore frames the SoP as setting the factual triggers that decision-makers apply under that civil standard.

Administrative scope. The SoP applies to claims under specific statutory sections: VEA s120B and MRCA s339 (section 5). It replaces the 2017 SoP for haemorrhoids (section 4), so decision-makers will apply the 2026 instrument from its commencement date (section 2).

Primary affected persons. The instrument affects veterans and members of the Forces who make claims for entitlements under the VEA or MRCA where haemorrhoids or death from haemorrhoids is alleged to be connected to relevant service (sections 5 and 7). It also affects dependants and estates to the extent a claim concerns death from haemorrhoids (section 7(5)).

Decision-makers and administrators. Administrative actors who decide claims under the VEA and MRCA are affected because they must apply this SoP when assessing whether haemorrhoids or death from haemorrhoids is service-related. The instrument is produced by the Repatriation Medical Authority (RMA) and therefore binds the medical standards used by decision-makers applying subsection 196B(3) references in the primary legislation (see section 3 and section 8). While the SoP does not identify specific decision-making agencies, it by design informs entitlement decisions under VEA s120B and MRCA s339 (section 5).

Healthcare providers and record-keepers. Clinicians, hospitals and other healthcare providers who document onset, clinical course, medication use, dietary advice or management of haemorrhoids will be indirectly affected. The SoP’s factors are evidence-driven; proof of pregnancy timing, spinal cord injury, medication records, diet or failure to obtain clinical management will be central to claim outcomes (sections 9 and Schedule 1 definitions).

Those providing goods or services related to clinical management. Where entitlement turns on "inability to obtain appropriate clinical management for haemorrhoids before clinical worsening" (s 9(8)), availability, access and waiting times for private and public clinical services become relevant factual inputs in claims. Providers, funders and policymakers who influence access to clinical management will thus be implicated in the factual landscape used in claims, although the instrument does not allocate liability for any service gaps.

Pharmaceutical supply chains and regulators. The Schedule defines anticoagulants and antiplatelet agents by class and lists examples such as heparin, warfarin, apixaban and clopidogrel (Schedule 1). Where a claim depends on medication exposure within specified time windows (s 9(7)), pharmacy records and prescribing documentation will be relevant.

Those affected by the repeal. Persons whose claims were assessed under the earlier 2017 SoP will be affected from the commencement date because the 2017 instrument is repealed (section 4). The instrument replaces that prior medical standard for haemorrhoids with the 2026 formulation.

Not affected by penalties. The instrument does not create criminal offences or administrative penalties within its text. Its effect is limited to establishing the medical-factual rules used in decision-making concerning claims under the VEA and MRCA (sections 3 and 5). Consequently, the instrument alters entitlement determinations rather than imposing fines or sanctions.

Duties implicit in the SoP. The instrument itself does not impose obligations framed as duties on citizens in the form of positive legal duties to act or refrain from acting. Instead the SoP imposes binding evidentiary rules and definitions that decision-makers must use when determining whether haemorrhoids or death from haemorrhoids are connected with relevant service for the purposes of VEA and MRCA claims.

Obligation on decision-makers to apply the SoP. Because the SoP is made by the Repatriation Medical Authority under subsection 196B(3), decision-makers assessing claims under VEA s120B and MRCA s339 are required to apply this medical standard when determining service connection for haemorrhoids. Section 8 states the RMA’s view of the medical-scientific evidence and sets the standard (section 8). The effect is that adjudicators must test a claimant’s evidence against the factors listed in section 9 and the definitions in Schedule 1.

Claimant evidentiary obligations. The SoP establishes which factual predicates, if proved on the balance of probabilities, will support a finding of service connection. A claimant therefore bears the practical task of adducing evidence that one or more of the section 9 factors existed and that the factor(s) are related to the person’s relevant service (see section 9 and section 10(1)). For clinical worsening aspects, claimants must also show that haemorrhoids were suffered or contracted before or during (but did not arise out of) relevant service if they rely on the clinical-worsening variants of the factors (section 10(2)). The SoP does not alter statutory procedural obligations under the VEA or MRCA; it defines the medical facts decision-makers will consider.

Rights and protections. The SoP frames decision-making by reference to the balance of probabilities and does not itself create procedural rights such as appeal or review rights. Any entitlement to internal review, merits review or judicial review will derive from the underlying statutes (VEA/MRCA), not from the SoP text. The instrument does, however, narrow or specify the factual pathways by which claimants can establish service connection for haemorrhoids or death from haemorrhoids (sections 7-9). Where a factor in section 9 refers to an injury or disease that is the subject of another SoP, section 11 requires the other SoP to be applied in accordance with its own terms.

Discretion and undefined thresholds. The SoP includes terms that will require evaluative judgement by medical assessors and decision-makers. For example, "inability to obtain appropriate clinical management" (s 9(8)) is not defined in the Schedule and will require a fact-based determination. Similarly, establishing an "inability to consume an average daily intake of 20 grams of fibre in food" (s 9(5)-(6)) is tightly specified in quantity but will depend on how clinicians and assessors evaluate dietary evidence. The Schedule gives a working definition of "fibre in food" (Schedule 1) but does not prescribe the form of proof.

Burden of proof and standard. The SoP assumes the civil standard of proof, expressed in the instrument as "more probable than not" (section 8). The claimant must establish one or more factors on that standard in the context of their particular claim; the SoP supplies the factual triggers that suffice if proven.

Interaction with other medical findings. Where a factor invokes another injury or disease covered by a different SoP, the other SoP's factors and terms apply (section 11). That cross-reference creates a duty on decision-makers to consult and apply multiple SoPs when a factor overlaps with another medically defined condition.

No statutory penalties in the instrument. The Statement of Principles does not create criminal offences, civil penalties or administrative sanctions within its text. Its legal function is to set medical-factual standards for use in entitlement determinations under the VEA and MRCA. There is no provision in the instrument imposing fines, imprisonment, or other penalties for non‑compliance by claimants, clinicians, providers or decision-makers.

Enforcement mechanism is administrative application in claims. The practical enforcement mechanism for the SoP is administrative: decision-makers assessing claims under VEA s120B and MRCA s339 apply the SoP’s definitions and factors to decide whether haemorrhoids or death from haemorrhoids are connected with relevant service (section 5). If a decision-maker finds that the requisite factor(s) are established and related to service, that factual conclusion informs entitlement outcomes under the primary legislation. Conversely, if no factor is established on the balance of probabilities, a claim will not succeed on that ground. The SoP therefore influences administrative outcomes but does not itself prescribe enforcement procedures.

No self-contained sanctions for misstatement. The instrument does not set out consequences for false statements by claimants or providers. Any penalties for false statements, fraud or related misconduct would be governed by the VEA, MRCA or other statutes and are not contained or modified by this SoP. The text is silent on sanctions.

Decision-maker obligations and review. The SoP is a medical standard that must be used by the agencies administering the VEA and MRCA when evaluating claims involving haemorrhoids. While the SoP does not provide review pathways, resulting administrative decisions remain subject to the review, appeal and judicial oversight frameworks established in the VEA and MRCA. Those statutory review rights are not modified by this instrument, and they are not described in the SoP itself.

Discretion in application. Several elements in the SoP require evaluative or discretionary judgements by medical assessors and decision-makers (for example, determining whether appropriate clinical management was obtainable before clinical worsening, s 9(8); assessing whether someone was unable to consume 20 grams of fibre daily, s 9(5)-(6); or determining whether a terminal event was "contributed to" by haemorrhoids, s 7(5) and Schedule 1). That discretion will be exercised within administrative decision-making and thus forms the locus where enforcement (i.e. acceptance or rejection of a claim) effectively occurs, even though the instrument itself contains no penalty regime.

Operative legal framework. The SoP is produced under subsection 196B(3) of the Veterans' Entitlements Act 1986 (VEA) and is expressly stated as applicable to claims to which VEA section 120B or MRCA section 339 applies (section 3 and section 5). The instrument therefore functions as a subordinate medical standard that feeds into determinations under those primary statutes. It does not amend or repeal provisions of the VEA or MRCA; instead it supplies the medical criteria decision-makers must apply when determining service connection for haemorrhoids.

Repeal of prior SoP. The instrument repeals the Statement of Principles concerning haemorrhoids (Balance of Probabilities) (No. 4 of 2017) (federal register No. F2017L00005) (section 4). From the commencement date (23 March 2026, section 2), the 2017 SoP is no longer the operative medical standard for haemorrhoids; decision-makers will apply the 2026 instrument when assessing relevant claims (section 4).

Cross-SoP interaction. Section 11 creates a direct interaction rule with other Statements of Principles made under subsection 196B(3) of the VEA. If a factor in section 9 refers to an injury or disease for which another SoP exists, the other SoP applies in accordance with its terms as in force from time to time (section 11). That means decision-makers must consult and apply the provisions of other SoPs where there is overlap. The result is a networked body of medical standards: this SoP does not operate in isolation where cross-referencing occurs.

Interaction with clinical coding. The instrument notes that haemorrhoids attracts ICD‑10‑AM code K64, O22.4 or O87.2, but states explicitly that, in applying the SoP, the meaning of haemorrhoids is that given in subsection 7(2) (section 7(4) and note). The ICD codes are therefore an adjunct reference and do not supplant the statutory definition in subsection 7(2). Decision-makers may, at their discretion, consider coding but must rely on the SoP’s definition.

Evidentiary and procedural law remains outside the SoP. The SoP sets medical-factual criteria; it does not alter statutory evidentiary rules, procedural fairness obligations, or review rights in the VEA or MRCA. Any changes to those procedural or remedial rules would require amendment to the primary statutes and are not effected by this instrument.

No express interaction with non-VEA/MRCA regimes. The instrument is framed solely for application in the VEA and MRCA contexts and does not purport to bind decision-making in other administrative or civil jurisdictions (for example workers compensation schemes, private insurance, or criminal proceedings). Any reliance on the SoP outside the VEA/MRCA framework would be a matter of external practice or judicial consideration, not an effect created by the SoP.

Definitions anchored in Schedule 1. The Schedule supplies definitions used throughout and aligns those medical and descriptive terms to the SoP’s operation. For example, "spinal cord injury" is defined as partial or complete injury causing motor and/or sensory deficits below the level of the lesion (Schedule 1), and this definition governs how s 9(3) operates in claims. Similarly, defined pharmacological classes are used to interpret s 9(7).

Single replacement recorded here. The only amendment history present in the instrument is the repeal of the prior Statement of Principles concerning haemorrhoids (No. 4 of 2017) (Federal Register No. F2017L00005) (section 4). The 2017 instrument is expressly repealed and replaced by this Statement of Principles concerning haemorrhoids (No. 20 of 2026). The instrument is dated 20 February 2026 and commences on 23 March 2026 (sections 1, 2 and the header material).

Instrument numbering and date. The instrument identifies itself as No. 20 of 2026 and includes signature/attestation material showing the Chairperson of the Repatriation Medical Authority (Professor Terence Campbell AM) signed on behalf of the RMA. Those administrative details serve as the immediate documentary record of this instrument’s making and commencement.

No amendments within the text other than definitions and factor listing. The SoP as presented does not include later in-text amendments, transitional provisions, or staged commencements other than the single commencement date. It does not include savings clauses for decisions made under the repealed 2017 SoP; the 2017 instrument is simply repealed (section 4). Any transitional handling of existing claims is governed by the VEA/MRCA administrative practice and not set out in this SoP.

Dependence on other SoPs for cross-referenced conditions. Section 11 contemplates that other SoPs may change over time and instructs that cross-referenced SoPs apply "as in force from time to time." That means the operation of this SoP as to certain factors may be affected by later amendments to other SoPs. The instrument itself does not catalogue those possible changes but creates an ongoing interaction whereby future amendments to other SoPs will dynamically affect how connected factors are assessed.

No amendment mechanism set out in this instrument. The SoP does not specify how it may be amended in future. The authority to make or amend SoPs flows from subsection 196B(3) of the VEA; any subsequent amendments would require a new instrument under that statutory power, as occurred here when replacing the 2017 instrument.

No cases or litigation recorded. The text of the Statement of Principles does not cite any court decisions or administrative tribunal rulings. It contains no litigation history, no list of precedential decisions, and no references to judicial interpretation of either the VEA, MRCA or prior SoPs.

Implication for legal challenge. Because the instrument is an administrative determination of medical-factual standards under subsection 196B(3) of the VEA, any legal challenge to decisions applying this SoP would arise from decisions made under the VEA or MRCA rather than from the SoP text itself. The instrument does not discuss appeal or review rights; those remain matters of the underlying statutes and administrative law. The SoP does not record whether the 2017 instrument was subject to litigation.

No judicial gloss in the SoP. The instrument provides medical definitions and factual factors without judicial commentary. Decision-makers applying these criteria may find themselves in disputes where claimants challenge factual findings or the application of cross-referenced SoPs; such disputes will be resolved in the statutory review or judicial review processes, but no historical litigation outcomes are supplied in this text.

No examples of contested applications. The SoP contains a technical note that clinical worsening may include increase in grade, bleeding and/or need for surgical intervention (note to subsection 7(2)), but offers no exemplars of contested adjudications or how tribunals have treated such matters. Consequently practitioners must reason from the text itself and the definitions in Schedule 1 when anticipating legal contest.

Differences between ICD coding and the statutory definition. The instrument notes that haemorrhoids attract ICD‑10‑AM codes K64, O22.4 or O87.2 but insists that the statutory meaning in subsection 7(2) controls when applying the SoP (section 7(4) and note). This means a claim that relies solely on a diagnostic code in isolation may fail if the clinical facts do not match the functional definition in subsection 7(2). Practitioners should not assume that an ICD code by itself guarantees satisfaction of the SoP.

Clinical worsening versus onset distinctions. Section 10(2) contains a subtle but important constraint: the clinical worsening aspect of the factors in section 9 applies only where the person’s haemorrhoids were suffered or contracted before or during (but did not arise out of) the person’s relevant service. That line creates a technical exclusion for conditions that did "arise out of" service. In practice, a claimant whose haemorrhoids first arose out of service but then worsened may fall outside the clinical worsening pathway under this SoP; they would need to rely on the onset elements or other relevant factors as they relate to service. Practitioners must therefore map whether haemorrhoids arose out of, during, or before service because that status changes which factors may be used to establish a causal link.

Proving temporally narrow windows. Many of the listed factors require tight temporal proof. Examples include straining at stool due to constipation or diarrhoea within two weeks before clinical onset or worsening (s 9(2)), pregnancy within six weeks before onset or worsening (s 9(1)), and medication use within 30 days before haemorrhoidal bleeding for clinical worsening (s 9(7)). Proving these precise windows will require contemporaneous clinical records, medication charts or other reliable documentary evidence. Absence of precise timing evidence may lead to unsuccessful claims despite probable causal linkages.

Dietary proof burden. The SoP requires proof of "an inability to consume an average daily intake of 20 grams of fibre in food" for either three months before onset (s 9(5)) or four weeks before clinical worsening (s 9(6)). Although "fibre in food" is defined in the Schedule, the instrument does not state what constitutes sufficient proof of "inability" (for example medical incapacity, access limitations, or personal choice). Demonstrating diet quantitatively over months will be difficult without clinical dietitian assessments, contemporaneous dietary records, or clinician statements. The difference in required duration for onset (3 months) and for worsening (4 weeks) is another potential source of procedural error.

Undefined "appropriate clinical management." Section 9(8) allows inability to obtain appropriate clinical management for haemorrhoids before clinical worsening as a factor. The SoP does not define "appropriate" nor does it set objective criteria for what constitutes inability to obtain management. That gives assessors latitude but also creates evidentiary uncertainty for claimants. Proving systemic or access failures,appointments unavailable, long public wait lists, or denial of services,will require documentary proof and may hinge on discretionary assessment.

Nonstandard exposure: chewing khat. Section 9(4) includes chewing khat at least weekly for at least the three months before onset or worsening as an alternative factor. Khat is an uncommon exposure in some Australian contexts; establishing frequency and duration will likely rely on self-reporting, cultural practice records, travel histories, or clinician notes. The SoP imposes a specific frequency and duration threshold, which must be matched in the evidence.

Pharmacological class definitions. The Schedule lists representative anticoagulants and antiplatelet agents by name and defines the classes. Section 9(7) links medication exposure to haemorrhoidal bleeding for clinical worsening when taken within 30 days before bleeding. Practitioners should note that the SoP’s classes are inclusive examples; assessors will need to map specific prescriptions to the Schedule’s classes to determine whether the medication exposure meets the factor.

Death linkage requires contribution. For death from haemorrhoids to be within the SoP, the terminal event must have been "contributed to" by the person’s haemorrhoids (section 7(5)). The Schedule lists examples of terminal events. Claimants must show a causal contribution rather than mere coincidence; that requires medical documentation linking haemorrhoids to the fatal sequence. Death certificates and treating clinician statements will need to reflect this contribution.

Cross-SoP dependencies. Where a factor in section 9 refers to another injury or disease that has its own SoP, section 11 triggers application of the other SoP "as in force from time to time." Practitioners must therefore identify any cross-references and apply multiple SoPs, which can complicate preparation and arguments if the other SoP has different timing, definitions, or thresholds.

Replaced prior instrument. The 2026 SoP repeals the 2017 instrument (section 4). Practitioners who rely on prior practice notes or precedents under the 2017 SoP should check whether factual pathways have shifted or thresholds tightened under the new instrument.

Evidence strategy mapped to each factor. For claimants and advisers, compliance means presenting evidence that establishes one or more section 9 factors on the balance of probabilities and that the factor(s) are related to relevant service (sections 9 and 10(1)). Practical evidence to collect for each enumerated factor includes the following:

• Pregnancy (s 9(1)): obstetric records, antenatal clinic notes, hospital admissions, or GP notes showing pregnancy timing to demonstrate pregnancy within six weeks before clinical onset or worsening.

• Straining at stool due to constipation or diarrhoea (s 9(2)): contemporaneous GP, emergency, or specialist notes documenting constipation, diarrhoea and straining episodes, bowel movement records, digital rectal exam findings, or clinician assessments within two weeks before onset/worsening.

• Spinal cord injury (s 9(3)): diagnostic imaging, hospital admission notes, surgical records, and specialist neurological reports confirming a partial or complete spinal cord injury that produced motor and/or sensory deficits below the level of the lesion, dated to the time of clinical onset or worsening (Schedule 1 definition).

• Chewing khat (s 9(4)): statements, travel or cultural practice records, specialist notes, or contemporaneous clinician documentation indicating frequency of khat chewing at least weekly for at least three months before onset/worsening. Where possible, corroborative statements from peers or family and dated declarations could strengthen the account.

• Dietary fibre inability (s 9(5)-(6)): dietitian reports, GP or specialist notes stating that the claimant was unable to consume an average daily intake of 20 grams of fibre for the required period, hospital diet sheets, meal records, or clinical assessments showing medical reasons for inability (for example severe dysphagia or gut malabsorption). Clinicians should explicitly quantify average daily intake in grams or explain why intake could not reach 20 grams.

• Medication exposure (s 9(7)): dispensing records, prescription charts, hospital pharmacy records, medication administration charts, or GP prescriptions demonstrating use of anticoagulants, antiplatelet agents or nonsteroidal anti-inflammatory drugs within 30 days before haemorrhoidal bleeding. Identify the specific agent and map it to the Schedule’s definitions (Schedule 1 lists heparin, warfarin, dabigatran, apixaban, rivaroxaban for anticoagulants and aspirin, clopidogrel, dipyridamole and monoclonal antibodies and peptides for antiplatelets).

• Inability to obtain appropriate clinical management (s 9(8)): documents showing appointment cancellations, referral rejections, long wait‑time notices, correspondence with public hospital or clinic administration, letters from GPs or specialists describing service unavailability, or other documentary proof that appropriate management was inaccessible before worsening.

Linking to relevant service. For each factor relied upon, the claimant must connect the factor to their relevant service (section 10(1)). Practical proof may include service records, deployment dates, service medical records showing clinical events occurred during or as a consequence of service-related activities, and contemporaneous documentation tying the factor to the period of relevant service. Where the factor is ongoing (for example dietary patterns or medication use), evidence should show the relevant service period overlapped with or preceded the factor.

Demonstrating pre‑existing haemorrhoids for clinical worsening claims. If relying on a clinical-worsening variant of a factor, the claimant must show the haemorrhoids were suffered or contracted before or during, but did not arise out of, relevant service (section 10(2)). That requires prior clinical notes or diagnostic records demonstrating the initial presence of haemorrhoids before the service event alleged to have caused clinical worsening.

Medical causation summaries. Obtain contemporary treating clinician statements that address medical causation and the relationship between the factor(s) and haemorrhoids, preferably referencing the timing and the SoP factors. For death claims, obtain death certificates and specialist reports that explicitly state whether haemorrhoids contributed to the terminal event(s) identified in Schedule 1 (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function).

Addressing ICD coding. If ICD‑10‑AM codes are present in records, also ensure clinical descriptions correspond to the statutory definition in subsection 7(2) and document that the haemorrhoids consisted of inflammation, bleeding, thrombosis, prolapse or symptomatic enlargement of the haemorrhoidal cushions.

Prepare for cross-SoP references. Identify whether any factor refers to conditions with their own SoPs and gather the evidence those other SoPs require, since section 11 mandates applying the other SoP’s terms where relevant.

Documentation quality and timing. Because many factors require precise temporal windows, ensure records contain dates, times, and clinician signatures where possible. Pharmacy and hospital records are typically strong for proving medication exposure and treatment access. Where subjective evidence (for example self-reported khat use or dietary intake) is central, support it with corroboration and clinician assessments.

Anticipate evaluative judgements. For factors that are not objectively defined in the instrument (for example "appropriate clinical management" or "inability" to consume fibre), include clinician opinions explaining why services were not obtainable or why dietary intake could not reach 20 grams per day. Where available, include system-level evidence such as hospital wait times or referral denials.

Administrative liaison. Ensure copies of service medical records and service dates are furnished to decision-makers to establish that the asserted factor is related to relevant service as required by section 10(1). Engage treating clinicians to produce explicit opinions tying clinical facts to service where appropriate.

Record retention and disclosure. Retain original clinical records, pharmacy records, and any correspondence demonstrating attempts to obtain management, because the SoP’s temporal specifications make retrospective reconstruction difficult. Where claimants are unable to produce documents, contemporaneous statutory declarations, sworn affidavits and clinician statements explaining why documents are absent will materially assist adjudicators.

Use of definitions. Refer to Schedule 1 when preparing evidence so that the language used by clinicians mirrors the SoP (for example, using the Schedule’s definition of anticoagulants, antiplatelet agents, fibre in food, spinal cord injury and terminal event).

This Statement of Principles sets medical-factual gates that adjudicators must apply when deciding whether haemorrhoids or death from haemorrhoids are connected with relevant service for claims under the VEA and MRCA (sections 3, 5, 7-11 and Schedule 1). Practitioners should map case facts to the precise factors and time windows in section 9, ensure relation to relevant service under section 10(1), and be ready to address the evaluative elements in the SoP where the instrument leaves matters to medical and administrative judgement.