Statement of Principles concerning hepatitis E infection (Balance of Probabilities) (No. 40 of 2024)

The Statement organises the medical and temporal concepts that a claims decision‑maker will apply when determining whether a veteran’s hepatitis E infection (or death from it) is connected with relevant service. Those concepts are explicit and limited in scope.

Definition of the injury

• “Hepatitis E infection” is defined as infection with hepatitis E virus resulting in an illness characterised by liver inflammation, and which is confirmed by laboratory testing for hepatitis E serological or nucleic acid markers (s 7(2)). The Schedule confirms that clinical onset is the backward point from first date of lab confirmation to the date when symptoms were persistently present, as assessed by a registered medical practitioner (Schedule 1 definition of clinical onset). The instrument notes that laboratory confirmation will usually occur after clinical onset (s 7(2) Note 3).

Clinical onset and clinical worsening

• Clinical onset is an assessment made by a registered medical practitioner tying symptoms and lab confirmation together (Schedule 1). The instrument recognises a concept of “clinical worsening”, including development of chronic hepatitis E from acute infection (s 7(2) Note 2) and treats death from hepatitis E or liver transplantation necessitated by hepatitis E as clinical worsening (s 9(4) Note). However, the instrument does not provide a separate statutory definition of “clinical worsening”; the term is used in the factors (s 9) and contextual notes.

Temporal windows and exposure pathways

• The principal exposure window for direct infection factors is 14 to 70 days before clinical onset (s 9(1)). Exposure pathways that satisfy s 9(1) include being in the same living quarters or immediate work environment as an infected person, consuming contaminated food or water, direct contact with faecal material from humans or primates, direct physical contact with an infected human or primate, percutaneous exposure to contaminated blood or body fluids, and transfusion of contaminated blood or blood products (s 9(1)(a)-(f)).

Transplantation, immunosuppression and pregnancy

• The Statement singles out transplantation scenarios as separate factors: receipt of a solid organ transplant (excluding corneal) from an infected donor within 4 months before clinical onset (s 9(2)); and having certain transplants (liver, kidney, heart, lung, stem cell or bone marrow) before clinical worsening (s 9(3)). It also lists pregnancy at time of death due to hepatitis E or at time of liver transplantation necessitated by hepatitis E (s 9(4)), and chemotherapy for cancer at time of clinical worsening (s 9(5)). These factors identify situations commonly associated with severe outcomes.

Healthcare access

• Inability to obtain appropriate clinical management for hepatitis E infection before clinical worsening is a listed factor (s 9(6)). The instrument does not set out standards for what constitutes “appropriate clinical management”; it lists inability to obtain it as supporting material contribution to clinical worsening.

Relationship to service and overlap with other SOPs

• A person must have one of the factors in s 9 related to their relevant service (s 10(1)). Subsections 9(3)-9(6) are limited to material contribution or aggravation where the hepatitis E infection was suffered or contracted before or during, but did not arise out of, relevant service (s 10(2)). If a factor in s 9 refers to an injury or disease covered by another Statement of Principles determined under s 196B(3) of the VEA, the other Statement applies as it stands (s 11).

Evidentiary implications

• Laboratory confirmation is mandatory for the definition of hepatitis E infection in this instrument (s 7(2)). Clinical onset is a backward assessment from lab confirmation, assessed by a registered medical practitioner (Schedule 1). The instrument therefore requires temporal linkage between onset and laboratory evidence, and between onset and exposure events described in s 9.

The Statement’s concepts are narrowly medical and temporal. It does not itself award compensation, set procedural rules for claims, nor define entitlements under VEA or MRCA. Its role is to provide a medically‑grounded causation framework for decision‑makers applying the VEA and MRCA (s 3, s 5, s 8).

The instrument is addressed to, and affects, people and decision processes in the following categories, as defined or implicated in the instrument.

Claimants

• Veterans and members of the Forces who make claims under the VEA or MRCA where causation between hepatitis E infection (or death from it) and relevant service is an issue. The instrument applies where section 120B of the VEA or section 339 of the MRCA is engaged (s 5). The Schedule defines “relevant service” to include eligible war service (other than operational service), defence service (other than hazardous service and British nuclear test defence service) under the VEA, and peacetime service under the MRCA (Schedule 1).

Decision‑makers and administrators

• The Repatriation Medical Authority made the instrument (s 3). The practical effect is to provide decision‑makers who determine claims under the VEA and MRCA with the set of medically‑based factors they should apply when assessing causation on the balance of probabilities, consistent with the statutory authority conferred by s 196B(3) of the VEA (s 3, s 8). The Department administering entitlements, tribunal members and medical assessors will be users of this Statement when deciding whether a person’s hepatitis E infection is connected with relevant service.

Medical practitioners and laboratories

• The definition of clinical onset specifically requires assessment by a registered medical practitioner (Schedule 1). Laboratory confirmation of hepatitis E serological or nucleic acid markers is mandatory to define the condition for the purposes of the Statement (s 7(2)). Thus treating clinicians and testing laboratories become de facto evidence providers for claims.

Interacting Statement of Principles and insurers

• Where a factor in s 9 refers to an injury or disease covered by another Statement of Principles, that other Statement applies (s 11). This creates an administrative interaction between different SOPs that may affect claimants whose exposures overlap multiple conditions. Private insurers or employers are not mentioned in the instrument, but claims under the VEA and MRCA may interact with other compensation schemes in practice; the instrument itself simply identifies which medical causal factors are to be adopted.

Who pays and who decides

• The instrument does not create a payment mechanism. It prescribes factors for causation assessments that feed into entitlement decisions under the VEA and MRCA. As a result, the ultimate payment or provision of entitlements remains governed by the VEA and MRCA and the decision‑making processes under those Acts. The RMA supplies the medical standard; decision‑makers under the Acts apply it.

Timing and transitional effects

• The instrument repeals the earlier SOP (s 4) and commences on a stated date (s 2), which affects which Statement will be applied to claims decided after commencement. The instrument itself does not specify transitional arrangements or retrospective effect beyond the text that it “applies to a claim to which section 120B of the VEA or section 339 of the MRCA applies” (s 5). Practitioners should note that the new Statement replaces the 2015 Statement for future application (s 4).

In short, affected parties include claimants seeking to establish service connection for hepatitis E, medical practitioners and laboratories providing evidence, and administrative decision‑makers who will apply the medical factors in adjudicating VEA/MRCA claims.

The Statement creates no new statutory duties or civil rights in itself. Its role is to set an evidentiary standard for causation in claims under the VEA and MRCA. Still, it produces practical duties of proof and rights to have a medical causation standard applied as follows.

Practical duties on claimants and their advisers

• Produce laboratory confirmation: The instrument defines hepatitis E infection to require laboratory testing for hepatitis E serological or nucleic acid markers (s 7(2)). A claimant, or their representative, must therefore secure and present those laboratory results if they are to rely on the Statement.
• Establish clinical onset: The Schedule requires clinical onset to be assessed by a registered medical practitioner, tracing back from the first date of lab confirmation to the date when symptoms were persistently present (Schedule 1). The claimant has the practical duty to obtain medical evidence that establishes that assessment.
• Prove a listed factor related to relevant service: To succeed under this Statement, at least one of the factors in s 9 must exist and be related to relevant service (s 9; s 10(1)). Therefore claimants must marshal evidence that links exposures, medical procedures, pregnancy status, chemotherapy, transplants or inability to obtain appropriate management to their service.

Decision‑maker duties

• Apply the Statement to causation questions: The RMA made the instrument under s 196B(3) of the VEA (s 3) and states its medical‑scientific view that hepatitis E infection can be related to relevant service (s 8). Decision‑makers adjudicating VEA/MRCA causation matters are required, by the statutory scheme that confers authority on the RMA, to apply Statements of Principles when determining service connection for specified conditions. The Statement therefore operates as the relevant medical benchmark for these claims.
• Give effect to overlapping SOPs: If a s 9 factor refers to an injury or disease subject to another Statement determined under s 196B(3), the other Statement applies as in force (s 11). Decision‑makers must therefore coordinate and apply the other SOP where relevant, rather than applying this Statement in isolation.

Rights

• Right to have medical causation assessed against this Statement: Claimants have the substantive right, in the sense that decision‑makers will use the Statement’s criteria when deciding whether hepatitis E infection is connected to relevant service. The Statement supplies the medical framework for a balance‑of‑probabilities causation finding (s 8).
• Right to rely on factors within defined time windows: The instrument specifies precise exposure windows and conditions (for example, exposure 14-70 days before clinical onset for s 9(1) factors; 4 months before clinical onset for s 9(2)). Where a claimant can demonstrate a factor within these parameters and related to relevant service, that factor supports a positive causation finding under this instrument.

Limitations and constraints (constructive duties)

• The Statement limits the application of s 9(3)-(6) to material contribution or aggravation where the infection was suffered or contracted before or during, but did not arise out of, relevant service (s 10(2)). Practically, this places an evidential constraint on claims that seek to rely on factors such as transplantation, chemotherapy, pregnancy at death, or inability to obtain appropriate management as causes or aggravators when the infection itself arose out of service.
• The instrument’s definition of hepatitis E infection excludes a sole reliance on an ICD‑10‑AM code. While it notes the code B17.2, it clarifies that the meaning for this SOP is that given in s 7(2) (s 7(3)-(4)). Thus claimants cannot substitute an ICD code alone for laboratory confirmation and the clinical onset assessment required by this Statement.

What the instrument does not do

• It does not create new criminal penalties, civil sanctions, or administrative fines. It does not itself confer entitlement to benefits; those remain governed by the substantive provisions and decision processes of the VEA and MRCA. It does not specify procedural rules for evidence admissibility or set timelines for claims processing.

In sum, the Statement creates practical evidentiary duties for claimants, establishes the medical right to have causation assessed against a specified set of factors, and constrains how certain aggravating factors may be applied in the service‑connection assessment.

The Statement of Principles is an administrative instrument that sets medical causation criteria for decision‑making under the VEA and MRCA. It does not itself create criminal offences, civil penalties or enforcement mechanisms. The instrument’s text contains no penalty provisions.

Administrative enforcement and application

• The Statement is made under subsection 196B(3) of the VEA (s 3) and expressly applies to claims to which section 120B of the VEA or section 339 of the MRCA applies (s 5). Enforcement, in practice, therefore occurs through the administrative claim processes under those Acts. The RMA supplies the medical standard; decision‑makers under the VEA and MRCA apply that standard when determining causation and, where causation is established, may give effect to entitlements provided by the substantive Acts. The instrument does not set or alter those entitlements.

Evidentiary effect in contested decisions

• The Statement has evidentiary force for causation assessments. Where a claimant satisfies one of the s 9 factors, as related to relevant service, the decision‑maker can treat that as sufficient to establish a causal connection on the balance of probabilities. Conversely, absence of any s 9 factor may be determinative against a finding of service connection in respect of hepatitis E. This is an administrative effect rather than a criminal sanction.

No statutory powers to compel

• The Statement does not give the RMA or another body powers to compel medical practitioners to act, nor does it prescribe sanctions for non‑compliance by treating clinicians or laboratories. It simply specifies the medical criteria decision‑makers must use. Any compulsion to produce material or sanction for non‑production would derive from the procedural powers of the decision‑making agencies under the VEA or MRCA or from tribunal or court processes, none of which are set out in this instrument.

Appeal and review pathways

• The instrument does not itself create appeal or review rights. Rights of review or appeal of entitlement decisions remain those provided by the VEA and MRCA and by general judicial review principles, as applicable. The Statement will be one element in the factual and medical matrix subject to review in administrative and legal proceedings, but the instrument itself contains no enforcement or penalty provisions.

Practical implications

• In practice, the Statement’s enforcement effect is operational and evidentiary: decision‑makers rely on it to accept or reject causation on balance of probabilities. The absence of an applicable s 9 factor materially affects the outcome of entitlement claims. That consequence is an administrative outcome in statutory compensation processes rather than a separate criminal or regulatory penalty imposed by this instrument.

The Statement is explicitly framed to operate within the statutory framework of the Veterans’ Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). It interacts with those Acts and with other Statements of Principles as follows.

Statutory basis and application

• The instrument is made under s 196B(3) of the VEA (s 3) and applies to claims to which VEA s 120B or MRCA s 339 apply (s 5). Those sections in the substantive Acts govern causation determinations and the application of Statements of Principles. As such, the Statement is an input into the decision‑making processes established by the VEA and MRCA rather than an independent source of entitlement.

Replacement of prior Statement

• The instrument repeals the previous Statement concerning hepatitis E (No. 113 of 2015) (s 4). From the commencement date, the new Statement supersedes the earlier one for claims to which it applies. Practitioners should therefore look to this instrument, not the 2015 version, when advising on causation for hepatitis E claims.

Interaction with other Statements of Principles

• Section 11 provides that where a factor in s 9 refers to an injury or disease that is the subject of another Statement determined under s 196B(3) of the VEA, the factors in that other Statement apply in accordance with its terms as in force from time to time (s 11). This creates an administrative hierarchy for overlapping medical conditions: decision‑makers must defer to the specialised Statement governing the other condition rather than attempting to apply this Statement to that aspect.

Relationship with medical coding and classification

• The Statement notes the ICD‑10‑AM code B17.2 for hepatitis E infection but specifies that, in applying this Statement, the meaning of hepatitis E infection is that given in subsection 7(2) (s 7(3)). It further clarifies the edition of the ICD‑10‑AM referenced (s 7(4)). This means that an ICD code alone is not determinative; decision‑makers must look to laboratory confirmation and the clinical criteria set out in this instrument.

Procedural law and evidence rules

• The Statement does not set procedural evidence rules or standards beyond its medical definitions and temporal criteria. Procedural matters such as disclosure obligations, record production powers, admissibility of expert evidence, or time limits are governed by the VEA, MRCA and associated regulations and tribunal rules, not by this Statement. Nonetheless, the Statement shapes the medical evidence that decision‑makers will require and the frame in which medical experts will be instructed.

Transitional and retrospective issues

• The instrument itself repeals the earlier Statement (s 4) and commences on a fixed date (s 2). It does not specify transitional provisions concerning claims lodged prior to commencement. Practitioners must therefore consider the usual administrative practice and the substantive Acts for guidance on whether a claim commenced or decided before commencement should be examined under the prior Statement. The instrument’s plain text does not resolve retrospective application.

Other Commonwealth, state or private law

• The Statement does not address or modify rights or obligations under other Commonwealth or state legislation, or under private contracts or insurance arrangements. However, determinations made using this Statement may have evidentiary or persuasive weight in other proceedings. The instrument itself imposes no requirement that other bodies accept its findings.

In summary, this Statement is a medical standard embedded in the statutory machinery of the VEA and MRCA. It supplants the 2015 Statement, cross‑refers to other SOPs where there are overlaps, overrides an ICD code as the sole defining criterion for the purpose of these claims, and leaves procedural and other legal issues to the substantive Acts and established administrative law processes.

The instrument records a narrow amendment history limited to its own commencement and the repeal of the earlier Statement of Principles.

• This Statement is issued as No. 40 of 2024 and commences on 23 July 2024 (s 1; s 2).
• It expressly repeals the Statement of Principles concerning hepatitis E (Balance of Probabilities) No. 113 of 2015, Federal Register of Legislation No. F2015L01333, previously made under subsection 196B(3) of the VEA (s 4).

The text does not record any other amendments, transitional provisions, or savings clauses. There is no express provision in this instrument governing claims lodged, decided or partially determined under the 2015 Statement prior to repeal. Practitioners should therefore note:

• The operative legal effect of the repeal is that, from commencement, decision‑makers should apply this Statement rather than the 2015 Statement in relation to claims to which s 120B of the VEA or s 339 of the MRCA applies (s 5).
• The instrument does not set out whether previously decided matters are to be re-opened or whether decisions already made under the 2015 Statement are affected.

Given the absence of transitional text, any question about how to treat claims commenced before 23 July 2024 will have to be resolved by reference to the administrative and legal framework of the VEA and MRCA and to any policy guidance issued by the administering Department or tribunal practices, none of which are contained in this instrument.

No other amendment history, side letters, or cumulative changes are documented in the text provided. The Schedule contains definitions that are part of this instrument and are therefore part of the current text from commencement.

The instrument contains no reference to any litigation history. It does not cite any case law, nor does it record being the subject of judicial review or litigation. The only judicial or administrative context provided is that the Statement is made under subsection 196B(3) of the VEA and is intended to inform causation determinations under the VEA and MRCA (s 3; s 5).

Because the instrument simply sets a medical‑scientific view and prescriptive factors for administrative decision‑makers, any litigation that might arise would be external to the instrument and would concern the application of the Statement by decision‑makers in particular cases under the VEA or MRCA. Such litigation would be governed by the procedural and review rights in those Acts and by general administrative law. The text does not supply examples of contested decisions or reported judicial consideration of the Statement.

Practitioners should therefore understand that:

• No cases are named or relied on in the instrument itself.
• The Statement’s legal implications will become apparent through its application in claims and any subsequent challenges in tribunals or courts, none of which are recorded in this text.

If a client needs to know whether judicial or tribunal bodies have accepted or rejected the medical propositions in this Statement, that information is not available within the instrument and would require searching judicial and administrative decisions post‑commencement.

This Statement contains a number of technical features, timing constraints and interaction rules that can materially affect claim outcomes. The following are concrete points that frequently catch claimants and advisers.

Laboratory confirmation is mandatory and determines clinical onset

• The instrument defines hepatitis E infection by reference to laboratory confirmation of serological or nucleic acid markers (s 7(2)). Clinical onset is calculated retrospectively from the first date of laboratory confirmation back to when symptoms were persistently present, as assessed by a registered medical practitioner (Schedule 1). Two practical consequences follow:
  • If a claimant lacks laboratory confirmation, the condition as defined by this Statement is not established.
  • Because clinical onset is tied to laboratory confirmation, delays in testing or absence of contemporaneous records can make it difficult to establish the relevant exposure windows, given the exposure window rules in s 9(1).

Exposure window is narrow and specific

• For s 9(1) exposure pathways, exposure must occur between 14 and 70 days before clinical onset (s 9(1) preamble). Many potential exposures will fall outside this window. Practitioners must map documented exposures precisely to the clinical onset assessed by a registered medical practitioner. Note 3 to s 7(2) expressly acknowledges that lab confirmation usually occurs after clinical onset, which increases dependence on retrospective clinical assessment.

ICD code is not a substitute for the Statement’s clinical definition

• The instrument notes hepatitis E infection attracts ICD‑10‑AM code B17.2 but states that, for the purposes of the Statement, the meaning is that given in s 7(2) (s 7(3)). Relying on a diagnostic code alone without laboratory confirmation and a clinical onset assessment risks rejection under this Statement.

Transplant and immunosuppression factors have different temporal rules and scope limits

• Section 9(2) requires a solid organ transplant from an infected donor within 4 months before clinical onset. Section 9(3) identifies certain organ and stem cell transplants before clinical worsening. However, s 10(2) confines subsections 9(3)-9(6) to situations where the hepatitis E infection was suffered or contracted before or during, but did not arise out of, relevant service. This can be counterintuitive:
  • If the infection itself arose out of service, a claimant cannot rely on these subsections to establish material contribution or aggravation.
  • For claims involving transplantation and subsequent clinical worsening, advisers must establish both the timing and whether the infection was contracted before or during relevant service without arising out of it.

Pregnancy and death

• Pregnancy at time of death due to hepatitis E infection or at time of liver transplantation necessitated by hepatitis E is a listed factor (s 9(4)). The Statement explicitly treats death due to hepatitis E infection and liver transplantation necessitated by hepatitis E infection as clinical worsening (s 9(4) Note). Advisers must therefore link pregnancy status and the timing of death or transplantation to relevant service and to the clinical onset/worsening chronology.

“Inability to obtain appropriate clinical management”

• Section 9(6) lists inability to obtain appropriate clinical management for hepatitis E before clinical worsening as a factor. The Statement does not define “appropriate clinical management” or set objective criteria. This gap can create disputes over what evidence will satisfy s 9(6) and invites rigorous forensic medical evidence and contemporaneous clinical records.

Overlap with other Statements of Principles

• Section 11 requires application of other Statements where a s 9 factor refers to a disease covered by another Statement determined under s 196B(3). Failure to check for overlapping SOPs can lead to incorrect reliance on this Statement where another SOP governs the particular causal pathway.

Repeal without transitional text

• The instrument repeals the 2015 Statement (s 4) and commences on a specified date (s 2) but includes no transitional provisions. Practitioners should verify which Statement is applicable to a given decision date and whether administrative practice treats pre‑commencement matters as governed by the 2015 Statement. The instrument is silent on retrospective operation.

Evidence quality and practitioner assessment

• Clinical onset must be assessed by a registered medical practitioner (Schedule 1). Poorly substantiated medical reports, or reports that do not clearly anchor symptoms to persistent presence prior to lab confirmation, risk failing the clinical onset test. Similarly, clinical worsening is referenced in the instrument but not fully defined, so medical evidence must explicitly address whether chronic infection has developed or whether death/transplantation constitutes clinical worsening under the Statement’s notes.

Administrative reliance rather than procedural guidance

• The Statement provides medical content but no procedural instructions for gathering evidence, timelines for production, or how to treat missing records. Decision‑makers will apply their usual statutory and administrative powers; claimants should be prepared to supply high‑quality contemporaneous medical and exposure records.

In practice, these “gotchas” mean that successful claims will generally require:

• Valid laboratory confirmation for hepatitis E markers;
• A registered medical practitioner’s retrospective clinical onset assessment;
• Clear documentary evidence mapping exposure or medical events to the stated exposure windows or transplant/immunosuppression scenarios;
• Where s 9(6) is invoked, detailed evidence showing lack of access to appropriate clinical management prior to clinical worsening.

This section sets out practical, source‑grounded steps and evidentiary checklist items for advisers preparing or assessing claims under this Statement. All references below are to provisions of the Statement itself.

1. Establish laboratory confirmation (s 7(2))

• Obtain the first laboratory report showing hepatitis E serological or nucleic acid markers. This is a threshold requirement for the condition as defined by the Statement. Where multiple labs exist, identify the earliest date of confirmation, as clinical onset is calculated from that date (Schedule 1). Without laboratory confirmation, the condition, as defined by this instrument, is not established.

2. Secure a registered medical practitioner’s assessment of clinical onset (Schedule 1)

• Commission or obtain a medical report from a registered medical practitioner that:
  • Identifies the first date of laboratory confirmation;
  • Records the dates when hepatitis E symptoms were first and then persistently present;
  • States the practitioner’s assessment tracing back from lab confirmation to the date of persistent symptoms, thereby fixing clinical onset as required by the Schedule 1 definition.
• Ensure the assessor addresses the usual clinical features listed in the Statement’s notes (for example, malaise, vomiting, abdominal pain, hepatomegaly, jaundice) so that the onset assessment is well‑grounded.

3. Map exposures and events to the Statement’s factors and time windows (s 9)

• For s 9(1) exposure factors, provide contemporaneous records or credible contemporaneous evidence that the exposure event occurred between 14 and 70 days before clinical onset. Typical evidence includes:
  • Service or accommodation records showing co‑habitation or shared quarters with an infected person;
  • Food or water contamination reports, public health notifications, or contemporaneous medical records linking gastroenteritis outbreaks to specific locations and dates;
  • Medical incident reports documenting percutaneous exposure to blood or body fluids, or transfusion records showing dates and donor testing status.
• For s 9(2), obtain transplant records proving receipt of a solid organ (excluding cornea) from an infected donor within the 4 months before clinical onset. Donor testing results, transplant operation notes and pathology reports will be necessary.
• For s 9(3), obtain records showing the claimant had one of the listed transplants before clinical worsening, and evidence of the timing of clinical worsening.
• For s 9(4), provide obstetric records or death certificates showing pregnancy status at time of death or at time of liver transplantation necessitated by hepatitis E; correlate to clinical worsening.
• For s 9(5), provide oncology treatment records demonstrating chemotherapy at the time of clinical worsening.
• For s 9(6), document attempts to obtain clinical management, records of referrals, treatment refusals, resource shortages, or other contemporaneous evidence showing inability to obtain appropriate clinical management prior to clinical worsening.

4. Demonstrate relationship to relevant service (s 10(1))

• The Statement requires that any s 9 factor relied upon be related to the person’s relevant service. Gather and submit:
  • Service records, employment logs, postings, deployment or accommodation records establishing presence in the relevant location or proximity to an exposure source during the relevant timeframe.
  • For medical procedures that occurred during or related to service, supply medical and service health records that show the link to service.

5. Observe scope limits for aggravation/material contribution (s 10(2))

• If relying on s 9(3)-(6) to show material contribution or aggravation, ensure the hepatitis E infection was suffered or contracted before or during, but did not arise out of, relevant service. Provide evidence to establish that chronology and causation. If infection arose out of service, these subsections will not apply per s 10(2).

6. Check for overlapping Statements of Principles (s 11)

• Where a factor refers to an injury or disease that is the subject of another Statement of Principles, identify that other Statement and apply its factors as in force (s 11). For example, if an exposure involves bloodborne pathogens covered by another SOP, gather and reference the relevant SOP and its evidentiary requirements.

7. Prepare medico‑legal linkage evidence for tribunal or review (where applicable)

• Anticipate that decision‑makers will require clear medico‑legal linkage: the medical report should explicitly state that, on the balance of probabilities, the s 9 factor(s) relate to the claimant’s hepatitis E infection and relevant service. Experts should address timing, pathogenesis, and the plausibility of the exposure pathway claimed.

8. Address the “inability to obtain appropriate clinical management” factor with contemporaneous evidence (s 9(6))

• Because the Statement does not define “appropriate clinical management,” if relying on this factor provide detailed contemporaneous clinical correspondence, referral and hospital records, and evidence of systemic barriers to care to demonstrate attempts and failures to obtain care before clinical worsening.

9. Be attentive to death and transplantation links to clinical worsening (s 9(4) note)

• Death due to hepatitis E and liver transplantation necessitated by hepatitis E are explicitly treated as clinical worsening. Where death or transplantation is asserted, provide death certificates, autopsy reports, transplant assessment notes and clinician narratives connecting hepatitis E to the terminal event or transplantation.

10. Watch for timing and record completeness issues

• Given the retrospective nature of clinical onset assessment and that laboratory confirmation is often after clinical onset (s 7(2) Note 3), ensure medical histories, symptom diaries, GP notes and hospital presentations are collected to enable reliable onset determination.

11. Administrative check list for submission

• Laboratory confirmation documentation (dates, test types).
• Registered medical practitioner’s clinical onset assessment and expert opinion linking factor(s) to hepatitis E and to relevant service.
• Service records and accommodation posting documents proving presence in the implicated environment.
• Transplant, transfusion, chemotherapy and obstetric records as applicable.
• Evidence of attempts to obtain appropriate clinical management where s 9(6) is invoked.
• Identification of any overlapping SOPs and relevant documents under those SOPs (s 11).

In short, compliance is built around obtaining the required laboratory confirmation, a registered medical practitioner’s retrospective clinical onset assessment, and clear documentary evidence tying the specified factor(s) to relevant service within the temporal windows the Statement requires. The Statement’s narrow definitions and timing windows mean that claim preparation must be forensic and evidence‑oriented rather than general or conclusory.