Statement of Principles concerning Hashimoto thyroiditis (Balance of Probabilities) (No. 2 of 2022)

Hashimoto thyroiditis is defined in section 7(2) as a chronic, inflammatory, autoimmune disease of the thyroid gland characterised by varying degrees of lymphocytic infiltration and fibrosis, typically presenting with a high titre of circulating antibodies against thyroid peroxidase or thyroglobulin. It includes goitrous thyroiditis, atrophic thyroiditis, and chronic autoimmune thyroiditis with transient thyrotoxicosis (Hashitoxicosis). It excludes Graves disease, non‑autoimmune chronic thyroiditis, postpartum thyroiditis, secondary hypothyroidism, and subacute thyroiditis. The definition governs all applications of the instrument, regardless of the ICD‑10‑AM codes assigned (E03.4, E03.5, E06.3).

Clinical onset refers to the first appearance of the disease. Factors 1-7 relate to clinical onset; factors 8-16 relate to clinical worsening. Worsening is described as material contribution to or aggravation of a pre‑existing condition. The instrument distinguishes between factors that cause the disease and those that aggravate it.

Balance of probabilities is the standard of proof for this instrument. Section 8 states that the Repatriation Medical Authority has determined on the sound medical‑scientific evidence available that it is more probable than not that Hashimoto thyroiditis can be related to relevant service. This is the threshold the claimant must meet.

Relevant service is defined in Schedule 1. It means eligible war service (other than operational service) under the VEA, defence service (other than hazardous service and British nuclear test defence service) under the VEA, or peacetime service under the MRCA. This is a critical limitation: the instrument does not apply to operational service, hazardous service, or British nuclear test defence service. Those service types are covered by a separate SoP under the reasonable hypothesis standard (made under subsection 196B(2) or (8) of the VEA).

Factors are listed in section 9. They are specific events or conditions that must exist for a causal connection to be drawn. They include iodine excess, taking certain drugs, therapeutic radiation, radioactive iodine treatment, obesity, postpartum thyroiditis, pregnancy/postpartum status, acute precipitating events (for myxoedema coma only), and inability to obtain appropriate clinical management. Each factor has a specific time window before clinical onset or worsening.

Death from Hashimoto thyroiditis is defined in section 7(5) as including death from a terminal event or condition that was contributed to by the person's Hashimoto thyroiditis. Terminal event is defined in Schedule 1 and includes pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function.

Iodine excess is defined in Schedule 1 as an average intake of more than 1,100 micrograms per day for adults (or more than 900 micrograms for those aged 18 and under) for a continuous period of at least three months, or having a urinary iodine concentration greater than 300 micrograms per litre (or greater than 500 for pregnant women). This is a measurable biochemical threshold.

Being obese means having a Body Mass Index of 30 or greater, as calculated by weight in kilograms divided by height in metres squared. This is a fixed cutoff with no reference to body composition or distribution.

Specified List 1 of drugs (for clinical onset) includes interferon alpha, interleukin‑2, and sunitinib. Specified List 2 of drugs (for clinical worsening) includes those three plus amiodarone and lithium. The instrument notes that taking a drug from List 2 must be for a continuous period of at least two weeks within the year before worsening.

Acute precipitating event is defined as a physical stimulus or event that causes a sudden, intense physical response. Examples given include abrupt cessation of thyroxine therapy, acute illness, iodine load, certain drugs, hypothermia, infection, physical trauma, and surgery. This factor only applies when Hashimoto thyroiditis first presents as myxoedema coma, or for worsening of myxoedema coma.

Section 11 provides that if a factor refers to an injury or disease covered by another Statement of Principles, that other SoP applies as in force from time to time. This cross‑references the entire SoP system.

This instrument directly affects veterans and members of the Defence Force who render relevant service as defined: eligible war service (non‑operational), defence service (non‑hazardous, non‑BNTDS), and peacetime service. It does not apply to those who served in operational service, hazardous service, or British nuclear test defence service; those claimants must rely on a separate SoP under the reasonable hypothesis standard. The instrument therefore creates a two‑tier system where the standard of proof differs depending on the type of service.

The instrument affects claimants who have or have had Hashimoto thyroiditis (or died from a terminal event contributed to by it) and who seek compensation or pension under the VEA or MRCA. They must prove that at least one factor in section 9 exists and that factor is related to their service. This imposes a significant evidentiary burden: medical records must show the diagnosis, the timing of clinical onset or worsening, and the presence of the factor within the specified window. Claimants must also document factors such as iodine intake (including supplements and medications), drug history (particularly for listed drugs), radiation exposure, body weight history, pregnancy history, and any acute precipitating events.

The instrument also affects decision makers in the Department of Veterans' Affairs and the Repatriation Commission. They are obliged to apply this instrument when determining liability. They cannot rely on general medical opinion that a connection is possible; they must check the specific factors. This reduces discretion and increases administrative consistency but also creates rigidity: if a factor is not present even though the disease might genuinely be service related, the claim must be rejected.

Medical practitioners who provide reports for claims are affected because they must understand the defined terms and time windows. For example, a report stating a veteran had "excess iodine" without quantifying the daily intake or urinary concentration may be insufficient. The definitions of iodine excess, obesity, and acute precipitating event are technical and require specific measurements.

The Repatriation Medical Authority is the maker of the instrument. Its determination under section 8 that it is more probable than not that the disease can be related to relevant service binds the decision‑makers. The Authority must rely on sound medical‑scientific evidence. The instrument can be challenged only on procedural or jurisdictional grounds, not on merits.

Legal representatives and advocates must be familiar with the instrument to advise clients on the likelihood of success. The instrument replaces common‑law causation with a checklist, which can simplify or complicate claims depending on the facts.

The public is indirectly affected as taxpayers funding the schemes. The specificity of the factors may either increase or decrease total payouts relative to a vague standard. For example, the obesity factor (BMI ≥30 for at least five years) may capture a large number of claimants, given the prevalence of overweight in the general population, but it requires evidence of sustained obesity. The drug lists are narrow; only five drugs are specified for worsening. This limits claims based on other medications that might trigger the disease.

No private enterprise is directly regulated, but the instrument may influence pharmaceutical companies and supplement manufacturers. For example, iodine supplements could become a source of claims if veterans can show they took excess iodine. The instrument does not impose duties on private actors; it only sets criteria for government compensation.

The instrument creates no duties directly on the claimant. Instead, it establishes the rights of the claimant to have the disease accepted as service connected if the factors are met. The primary duty falls on the decision maker under the VEA and MRCA: they must apply this instrument when determining whether Hashimoto thyroiditis relates to relevant service. The instrument is subordinate legislation, and the decision maker has no discretion to disregard a factor if it is established or to invent new factors not listed.

A claimant has the right to rely on any of the 16 factors to support their claim. They also have the right to have their claim assessed under the balance of probabilities standard if their service is relevant service. However, the instrument imposes a condition: the factor must be related to the person's relevant service (section 10(1)). This is a factual inquiry: the claimant does not merely have to show the factor existed; they must show that the factor arose out of, or was contributed to by, their service. For example, a claimant who became obese after service cannot rely on the obesity factor unless the obesity itself is service related. The instrument does not define how to prove that relationship; it is left to general causation principles under the VEA and MRCA.

Section 10(2) provides that factors 8 to 16 (the worsening factors) apply only to material contribution to or aggravation of Hashimoto thyroiditis where the disease was suffered or contracted before or during (but did not arise out of) the person's relevant service. This means a claimant with pre‑existing Hashimoto thyroiditis can only rely on worsening factors if the disease did not arise out of service. If the disease already arose out of service, the worsening factors are unnecessary; the claim is already accepted.

Section 11 gives a cross‑referencing right: if a factor refers to an injury or disease covered by another SoP, the factors in that other SoP apply. This means the claimant may need to satisfy two sets of factors: the factor here (e.g., postpartum thyroiditis) may itself require proof under a separate SoP. This creates a layered causation chain.

The right to have the instrument applied is limited to claims to which section 120B of the VEA or section 339 of the MRCA applies. These sections govern the standard of proof and the role of SoPs. If a claimant’s service is operational service, the instrument does not apply, and the claimant must rely on a different SoP under the reasonable hypothesis standard.

The instrument does not create any private rights of action or duties on health professionals. However, a medical report that fails to address the instrument’s definitions may lead to rejection of a claim, which is a de facto duty on the expert to ensure compliance.

The right to compensation is contingent on meeting the factor and relationship test. The instrument does not guarantee acceptance; it only provides a pathway. The decision maker must still be satisfied on the balance of probabilities after considering all evidence. The factor is a necessary but not sufficient condition.

This instrument does not itself impose penalties. It is not a criminal or regulatory instrument; it is a legislative rule for determining entitlement to benefits. Enforcement is therefore not about punishing non‑compliance but about correctly applying the instrument in administrative decision‑making. The primary enforcement mechanism is review.

A decision made without applying this instrument correctly can be challenged in the Veterans' Review Board (VRB) and then the Administrative Appeals Tribunal (AAT). If the decision maker fails to consider a relevant factor or misapplies the time windows, the decision may be set aside. The VRB and AAT have powers to substitute their own decision on the merits. The instrument does not provide for civil or criminal penalties for claimants who provide false information; however, general offences under the Criminal Code for making false or misleading statements in connection with a Commonwealth benefit apply. A claimant who knowingly fabricates a factor (e.g., fake iodine excess records) could face prosecution under section 135.1 or 135.2 of the Criminal Code (obtaining a financial advantage by deception). That is not unique to this instrument; it applies to all DVA claims.

The Repatriation Medical Authority is not subject to penalty but must act within the scope of subsection 196B(3) of the VEA. If a factor is not based on sound medical‑scientific evidence, the instrument could be challenged in the Federal Court on jurisdictional grounds. Judicial review under the Administrative Decisions (Judicial Review) Act 1977 or section 75(v) of the Constitution could lead to the instrument being declared invalid. The source text does not indicate any history of such challenges.

The VEA and MRCA contain their own enforcement provisions for overpayment of pension: if a pension is paid based on a claim that later is found to be unsupported by the SoP due to error, the Secretary may recover the overpayment. This instrument does not create any special enforcement regime; it is ancillary to the main benefits legislation.

In terms of compliance costs, the instrument imposes a burden on the DVA to train decision makers and maintain up‑to‑date versions. The repeal of the earlier SoP means old decisions based on No. 32 of 2013 are not automatically reopened; the instrument only applies to claims made after its commencement (section 5 and the general law). However, section 5 states it applies to a claim to which section 120B or 339 applies, which could include claims that are not yet final. The instrument does not specify retrospective effect, but it is a legislative instrument and likely applies to claims made after commencement. The repeal of the old SoP may affect existing claims that have not been determined; the new instrument will apply.

There is no penalty for failing to comply with the definitions; rather, the consequence is that a claim may fail if the evidence does not match. The instrument therefore disciplines the behaviour of claimants and their advisors to produce precise evidence. This can be seen as a compliance burden: claimants must invest in medical record retrieval, dietary analysis, and drug histories that might otherwise be unnecessary.

This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. It operates within the framework of that Act, particularly sections 120B and related provisions that govern the standard of proof and the role of Statements of Principles. It does not override the VEA; it fills in the medical causation test. The VEA itself provides that the Repatriation Commission must be satisfied that the disease is connected with service, and this instrument guides that satisfaction.

The instrument also applies to claims under section 339 of the Military Rehabilitation and Compensation Act 2004. That section imports the SoP regime from the VEA for peacetime service and defence service. So the instrument has dual application, covering both VEA and MRCA claims.

The instrument repeals the earlier Statement of Principles No. 32 of 2013. That repeal is substantive: any claim decided after 31 January 2022 must refer to this instrument, not the old one. The old instrument’s factors may have been different; claimants who relied on the old factors in a pending claim may be disadvantaged if the new factors are narrower. The instrument does not provide transitional provisions.

Section 11 of this instrument states that if a factor refers to an injury or disease covered by another Statement of Principles, that other SoP applies as in force from time to time. For example, factor 6 references "postpartum thyroiditis". That condition has its own SoP. The definition of postpartum thyroiditis and its connection to service will be governed by that separate SoP. This creates a chain of instruments that the claimant must satisfy.

The instrument interacts with the ICD‑10‑AM classification system, noting in section 7(3) that while Hashimoto thyroiditis attracts codes E03.4, E03.5, or E06.3, the meaning is given by the instrument, not the code. This avoids any conflict if the coding changes. The instrument references the Tenth Edition (2017) as a fixed version.

The instrument also interacts with common law principles of causation but overrides them for the purposes of VEA and MRCA claims. It is a complete code for the medical component of the causation inquiry. If a factor exists, the decision maker must accept that the disease can be related to service; if no factor exists, they must find that it cannot, unless other evidence is capable of overcoming the SoP (which is limited given the balance of probabilities standard and the Authority’s conclusion). The instrument essentially creates a conclusive medical presumption once a factor is proved.

It does not interact with state workers' compensation or motor vehicle accident schemes, as those are separate from military compensation. However, it may interact with the Safety, Rehabilitation and Compensation (Defence‑related Claims) Act 1988 for certain claims, but the instrument explicitly references only VEA and MRCA.

The instrument's definitions of "relevant service" and "terminal event" interact with other provisions of the VEA and MRCA. For example, "eligible war service" is defined in the VEA, and this instrument uses that term. The interaction is one of incorporation by reference.

There is no interaction with private health insurance or Medicare, as the instrument concerns liability for compensation, not medical coverage.

The source text provides only one explicit amendment: the repeal of the Statement of Principles concerning Hashimoto's thyroiditis No. 32 of 2013 (Federal Register of Legislation No. F2013L00731) made under subsections 196B(3) and (8) of the VEA. That earlier instrument is replaced by this new instrument commencing 31 January 2022. No other amendment history is stated. The instrument does not amend any other legislation; it is a standalone instrument.

The repeal is significant because the old instrument covered both the balance of probabilities standard (subsection 196B(3)) and the reasonable hypothesis standard (subsection 196B(8)). The new instrument is made only under subsection 196B(3), meaning it applies only to claims where the standard of proof is balance of probabilities. There is no new instrument covering the reasonable hypothesis standard for Hashimoto thyroiditis; the old one was repealed, so presumably all claims (including those with operational service) now fall under this balance of probabilities instrument? That seems unlikely, because operational service claims require the reasonable hypothesis standard under section 120(1) and (3) of the VEA. However, the source text does not mention a replacement for subsection 196B(8). This is a notable omission: the old instrument covered both standards; the new one covers only one. The consequence is that for operational service, hazardous service, and British nuclear test defence service, there may be no current SoP covering Hashimoto thyroiditis. This could be a drafting oversight or the authority may have determined that only one standard is needed. But the user's source text is only this instrument; we cannot assume anything beyond what is written. The instrument itself says it repeals the previous SoP No. 32 of 2013. That previous SoP covered both standards. This instrument is made under s196B(3) only. Therefore, from 31 January 2022, there is no SoP under s196B(8) for Hashimoto thyroiditis. This could mean that for operational service, the reasonable hypothesis standard applies but without a SoP, so the decision maker must rely on general medical evidence. That would be a significant change.

The instrument also amends the dictionary: it includes definitions such as "acute precipitating event", "being obese", "BMI", "iodine excess", "myxoedema coma", "Specified List 1 of drugs", "Specified List 2 of drugs", and "terminal event". These definitions did not appear in the old instrument in the same form. The inclusion of obesity and drug lists extends the factors beyond the earlier instrument.

No other amendments are referenced. The instrument does not list its own amendment history, but it is a new instrument that will be subject to future amendments. The authority has the power to amend or repeal it under the same subsection.

There is no mention of any transitional provisions from the old instrument to the new. That could cause difficulties for claims lodged before commencement but not yet determined. The instrument would apply to claims made on or after 31 January 2022, but for claims made earlier, the old SoP applies. Section 5 states the instrument applies to a claim to which section 120B or 339 applies. That is not a temporal provision; it simply says if the claim is of that type, this instrument applies. There is no explicit statement about retrospective operation. Under the Acts Interpretation Act 1901, a legislative instrument does not apply retrospectively unless it says so. Therefore, claims made before 31 January 2022 are governed by the old SoP. Claims made after that date are governed by this instrument.

The source text provides no litigation history. No cases are cited. This is typical for a Statement of Principles; they are legislative instruments, not court judgments. However, the instrument will inevitably be the subject of review applications in the Veterans' Review Board and the Administrative Appeals Tribunal. Those decisions are not mentioned in the source.

We can state that no litigation is referenced in the instrument, but note that the factors and definitions are likely to be litigated in individual claims. For example, the definition of "iodine excess" with its precise microgram thresholds may be contested if a claimant had average intake slightly below the threshold but still developed Hashimoto thyroiditis. The instrument does not allow for exceptions. Claimants may argue that the measurement method was inaccurate, or that the time window should be flexible. The VRB and AAT will have to interpret the instrument strictly.

Also, the exclusion of operational service from "relevant service" could be challenged if a claimant argues that their operational service contributed in a way equivalent to peacetime service. But the instrument clearly defines relevant service to exclude operational service; any challenge would be to the legal validity of that limitation, which would likely require a challenge to the VEA itself. The Authority cannot extend the instrument beyond the service types specified in the VEA.

The repeal of the old SoP without a replacement for the reasonable hypothesis standard might lead to litigation if a veteran with operational service claims that the inability to rely on a SoP violates their rights. However, the VEA allows the decision maker to determine the claim on the basis of all relevant evidence if no SoP exists. So it is not necessarily unlawful.

The instrument’s inability to obtain appropriate clinical management factor may be a frequent source of disputes: what constitutes "inability to obtain"? Is it a shortage of specialists, financial barriers, or geographic location? The instrument does not define it. The VRB will need to develop case law.

The acute precipitating event definition lists examples but does not exhaust them. The non-exclusive list leaves room for interpretation; a claimant might argue a novel event qualifies.

The obesity factor using BMI alone may be challenged if a claimant has a high muscle mass. But BMI is a fixed measure; the instrument does not allow adjustments. This could be litigated as an arbitrary threshold.

In summary, while no litigation is reported in the source, the instrument will generate individual proceedings. The instrument is designed to reduce the need for medical evidence battles, but the precise definitions and time windows will create new battles over factual evidence.

Several traps exist for claimants, decision makers, and advisors. First, the distinction between clinical onset and worsening factors is critical. Factors 1-7 apply only to clinical onset; factors 8-16 apply only to clinical worsening. If a claimant has a pre‑existing Hashimoto thyroiditis that was not service related, they cannot use factors 1-7 to claim a new onset; they must use the worsening factors. And section 10(2) limits the worsening factors to cases where the disease was suffered or contracted before or during (but did not arise out of) the person’s relevant service. So if the disease arose out of service (e.g., due to a previous factor), the worsening factors are not needed. But if the disease arose out of service, the claimant would have already had a successful claim. The trap is that a claimant who has Hashimoto thyroiditis that worsened during service might try to rely on onset factors, but if the original onset was before service, that route is closed.

Second, the time windows are strict. Iodine excess must be within three months before clinical onset or worsening. Drug from List 1 within one year before onset; drug from List 2 within one year before worsening and for a continuous period of at least two weeks. Radiation exposure within ten years. Obesity for at least five years before. Postpartum thyroiditis within ten years. Pregnancy or within 12 months postpartum for worsening. These windows mean that a veteran who had iodine excess four months before diagnosis cannot rely on factor 1. The instrument does not allow any leeway.

Third, the definition of iodine excess requires either an average intake of more than 1,100 micrograms per day (adults) for a continuous period of at least three months, or a urinary iodine concentration greater than 300 micrograms per litre. Most people do not measure their iodine intake. Proving the continuous period may require dietary logs or supplement records. The note says iodine excess may be due to foods, dietary supplements, or medications, but the burden is on the claimant to prove the quantitative threshold.

Fourth, the drug lists differ between onset and worsening. List 1 (onset) has only three drugs: interferon alpha, interleukin‑2, and sunitinib. List 2 (worsening) adds amiodarone and lithium. A claimant who took amiodarone but had clinical onset after that drug cannot use it; it is only a worsening factor. Also, the drug must be taken for a continuous period of at least two weeks for worsening. A single dose does not count.

Fifth, the obesity factor requires a BMI of 30 or greater for at least five years before clinical onset or worsening. The instrument does not define how to calculate the BMI historically. Claimants may need medical records showing weight over time. The five‑year period must be continuous; intermittent periods of obesity likely do not count.

Sixth, the acute precipitating event factor applies only for Hashimoto thyroiditis first presenting as myxoedema coma (factor 7) or for worsening of myxoedema coma (factor 15). If the claimant has Hashimoto thyroiditis without myxoedema coma, this factor is irrelevant. Also, the event must be within 48 hours before the clinical onset or worsening. That is a very short window.

Seventh, the relevant service definition excludes operational service, hazardous service, and British nuclear test defence service. A claimant who served in operational service will have their claim assessed under a different standard and possibly without a SoP if the earlier SoP was repealed and not replaced. This is a major structural trap: the instrument may not apply to the most combat‑exposed veterans.

Eighth, the inability to obtain appropriate clinical management factor (factor 16) is vague. It carries no time window, but it must be related to service. It likely applies only to worsening. What constitutes inability? A delay in treatment? Lack of access to an endocrinologist? The instrument does not say. It could be the hardest factor to prove or the easiest, depending on interpretation.

Ninth, section 11 cross‑references other SoPs. If a factor refers to another disease (e.g., postpartum thyroiditis, obesity is not a disease but a risk factor), that disease’s SoP must be satisfied. This multiplies the factual requirements.

Tenth, the definition of death includes a terminal event contributed to by Hashimoto thyroiditis. The terminal event list is exhaustive: pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function. If a veteran dies from a heart attack that is not accompanied by documented Hashimoto thyroiditis as a contributing factor, the claim may fail. The instrument does not define “contributed to” in any measurable way.

For a claimant seeking to have Hashimoto thyroiditis accepted as service connected under this instrument, the first step is to confirm that the person’s service is “relevant service” as defined: eligible war service (non‑operational), defence service (non‑hazardous, non‑BNTDS), or peacetime service. If the service is operational service, this instrument does not apply; the claimant should seek advice on the alternative standard.

The next step is to obtain a confirmed diagnosis of Hashimoto thyroiditis that meets the definition in section 7(2). This requires a medical report stating the presence of chronic inflammation, lymphocytic infiltration, and antibodies to TPO or thyroglobulin. The claimant should ensure that the diagnosis excludes Graves disease, non‑autoimmune chronic thyroiditis, postpartum thyroiditis, secondary hypothyroidism, and subacute thyroiditis. The ICD‑10‑AM code is not determinative; the clinical definition governs.

Then the claimant must identify which of the 16 factors may apply. For each factor, the claimant must gather evidence of the factor’s existence within the specified time window before either clinical onset (factors 1-7) or clinical worsening (factors 8-16). The evidence must also show that the factor is related to the person’s relevant service. This is often the hardest element. For example, if the factor is iodine excess from dietary supplements, the claimant must show that the supplements were taken as a result of service conditions (e.g., issued by the military, or taken because of service‑induced iodine deficiency). If the factor is obesity, the claimant must show that the obesity is service related (e.g., due to service injuries limiting exercise). The instrument does not provide any presumption of service connection for the factors; they must each be linked.

For factor 1 or 8 (iodine excess), the claimant should compile records of iodine intake: food diaries, supplement purchases, medication records (e.g., amiodarone but that is a separate drug factor). A urinary iodine concentration test done during the relevant period would be strong evidence. If retrospective, the claimant may need to reconstruct average daily intake. The threshold: adults > 1,100 μg/day for three continuous months; ages 18 and under > 900 μg/day; pregnant women > 500 μg/L urine. The excess must be within three months before onset or worsening.

For factor 2 (drug from List 1) or factor 9 (drug from List 2), the claimant needs pharmacy records, medical prescriptions, or service medical records documenting the drug and the dates. For factor 9, continuous period of at least two weeks must be shown. The drug must be taken within one year before the clinical event.

For factor 3 or 10 (therapeutic radiation) , the claimant needs oncology records showing the course of radiation, the field including the thyroid, and the date. The radiation must be for cancer, not for other conditions. The window is ten years before clinical onset or worsening.

For factor 4 or 11 (radioactive iodine treatment) , the claimant needs records of iodine‑131 administration, typically for hyperthyroidism or thyroid cancer. Same ten‑year window.

For factor 5 or 12 (obesity) , the claimant must demonstrate a BMI ≥ 30 for at least five years before onset or worsening. Historical weight records (annual medicals, enlistment records, service medicals) are needed. BMI must be calculated using height and weight; a current BMI of 30 does not suffice if the claimant was not obese for the prior five years.

For factor 6 or 13 (postpartum thyroiditis) , the claimant needs evidence of that specific diagnosis within ten years before onset/worsening. The diagnosis must meet the definition in the separate SoP for postpartum thyroiditis (if one exists). The claimant will need to satisfy that SoP as well.

For factor 14 (pregnancy or within 12 months postpartum) , evidence of pregnancy or postpartum status at the time of clinical worsening. This factor applies only to worsening, not onset.

For factor 7 or 15 (acute precipitating event for myxoedema coma) , the claimant must have had Hashimoto thyroiditis first presenting as myxoedema coma or worsening of myxoedema coma. Documentation of the coma and the event within 48 hours is required. The acute precipitating event can be broad (infection, surgery, drug cessation, etc.). The claimant needs medical records showing both the coma and the precipitating event.

For factor 16 (inability to obtain appropriate clinical management) , the claimant must show that appropriate clinical management for Hashimoto thyroiditis was not available and that this contributed to worsening. This could involve geographic remoteness, military‑imposed restrictions, or lack of follow‑up care. The claimant should document any requests for treatment that were denied or unavailable.

After assembling evidence, the claimant submits a claim to DVA. The decision maker will check each factor. If the claimant cannot prove a factor, the claim will likely be rejected unless the decision maker is satisfied by other evidence that the disease can be related to service despite the instrument (which is improbable given the Authority’s determination that factors are required).

Decision makers should maintain a checklist of the 16 factors and the time windows. They should ensure that the evidence meets the definitions exactly. For example, “being obese” requires BMI calculation, not clinical impression. “Iodine excess” requires quantitative evidence.

Legal representatives should be aware that the instrument is a legislative instrument and must be applied as law. They should request from DVA the factors analysis in writing. If a factor is accepted, the claim should succeed. If a factor is rejected, the representative should examine whether the evidence was properly interpreted.

All parties should note that the instrument does not provide for discretion. Compliance is a matter of matching facts to definitions. The onus is on the claimant to prove the factor and service relationship. The instrument does not allow for exceptions based on hardship or atypical presentations. Therefore, thorough documentation within the instrument’s framework is the only path to a successful claim.