Statement of Principles concerning ischaemic heart disease (Balance of Probabilities) (No. 28 of 2025)

The SoP builds around several discrete legal and medical concepts that determine how a claimant’s ischaemic heart disease will be assessed for service connection. These main concepts are: the statutory basis and scope, the causal standard, the enumerated factors, temporal linkage, definitions that convert clinical terms into legal thresholds, and cross‑application with other SoPs.

Statutory basis and scope. The instrument is an RMA determination under subsection 196B(3) of the VEA (Authority, s3). It applies specifically to claims under VEA s120B and MRCA s339 (Application, s5). The medical scope of the injury/disease is defined in s7(2): the SoP’s definition of ischaemic heart disease includes myocardial infarction (STEMI and NSTEMI), angina pectoris (including unstable angina and Prinzmetal angina), ischaemic cardiomyopathy and acute coronary syndrome; it excludes coronary artery disease without ischaemia, and myocardial infarction due to generalised hypoxia, vascular shock or cardiac arrest (s7(2)(a)-(c)).

Causal standard. The RMA states that, on the balance of probabilities, ischaemic heart disease can be related to relevant service (s8). That is the ordinary civil standard of proof. The SoP is titled “Balance of Probabilities”, and the choice of standard matters because it shapes how the enumerated factors will be applied by decision‑makers. The instrument does not set a higher standard such as "beyond reasonable doubt"; it sets the civil standard.

Enumerated factors as necessary gates. Section 9 states that at least one of the listed factors must exist before connection can be said, on the balance of probabilities, to the person’s relevant service. The factors are organised into categories: long‑standing risk states (for example hypertension, diabetes, obesity for 5 years), lipid abnormalities with precise numeric cut‑offs or on lipid‑normalising therapy, smoking exposure and pack‑year calculations, second‑hand smoke hours thresholds, physical inactivity thresholds (METs), chronic kidney disease criteria with defined GFR and albuminuria cut‑offs, autoimmune and vasculitic diseases, certain medications and their precise timing relative to onset (commonly within 24 hours), specific acute exposures (ambient temperature extremes over a defined period, envenomation within 24 hours, acute cholinergic poisoning within 1 week), infectious triggers (SARS‑CoV‑2 within 3 months, influenza or lower respiratory tract infection within 30 days), and discrete stressful events with defined temporal windows (category 1A or 1B stressors within 24 hours, acute severe stressful event within 12 hours, death of family/close friend within 1 week).

Temporal linkage and relation to service. Section 10(1) requires that any factor established must be related to the person's relevant service. Section 10(2) clarifies that the “clinical worsening” aspects of the factors only apply to material contribution or aggravation where the ischaemic heart disease was suffered or contracted before or during (but did not arise out of) the person's relevant service. That distinction introduces two different use cases: (a) establishing that ischaemic heart disease arose out of service (which is outside the “clinical worsening” usage), and (b) establishing that service is materially contributing to the worsening of pre‑existing disease. The instrument leaves to decision‑makers the task of linking the timing of factor occurrence to both clinical onset/worsening and relevant service.

Definitions converting clinical measures into legal thresholds. Schedule 1 supplies operational definitions: being obese is BMI ≥30 or waist circumference thresholds (males >102 cm, females >88 cm); BMI is W/H2 (weight in kg divided by height in metres squared); pack‑year is 20 cigarettes per day for a year or equivalent (with an example conversion note and calculation method); category 1A and 1B stressors are listed; clinically significant disorder of mental health is defined as severity warranting ongoing management; terminal event is given a list of proximate causes of death; hypertensive emergency is defined by blood pressure thresholds and organ impairment. These definitions make the SoP administrable but create strict numeric and categorical gates.

Cross‑application with other SoPs. Section 11 establishes that if a factor in this SoP refers to an injury or disease for which another SoP has been determined, then that other SoP’s factors apply as they are in force. This creates interdependence among SoPs and requires decision‑makers to consult other SoPs where relevant (for example, if a factor references chronic kidney disease and there is an existing CKD SoP).

Operational notes in the text. The SoP also notes that while ischaemic heart disease aligns with certain ICD‑10‑AM codes (I20-I25), the statutory meaning for the SoP is the textual definition in s7(2) and the ICD reference is effective for coding purposes only (s7(4)-(5)). The Schedule contains examples and non‑exhaustive lists (for instance examples of hypercoagulable states), which means the list is illustrative in some places and prescriptive in others; that will affect how decision‑makers interpret items not explicitly named.

In aggregate, these main concepts convert a broad clinical syndrome into a legally specified set of thresholds and event windows that determine whether a veteran’s ischaemic heart disease will be treated as connected with service in the VEA/MRCA claims environment.

Primary affected persons are claimants under the VEA or MRCA who assert ischaemic heart disease, or death from ischaemic heart disease, as connected to relevant service. The instrument expressly applies to claims to which section 120B of the VEA or section 339 of the MRCA apply (Application, s5). That covers veterans and members of the Forces who seek entitlements under those Acts for ischaemic heart disease, including survivors making death claims where death was contributed to by ischaemic heart disease (Death from ischaemic heart disease, s7(6)).

Decision‑makers and administrators are also directly affected. The RMA has provided the evidentiary criteria that the Department and the Veterans’ review and appeals bodies will use to determine causation. The instrument standardises the evidence that will commonly be requested and assessed, including laboratory results (lipid levels, GFR, albumin‑to‑creatinine ratio), anthropometric measurements (BMI, waist circumference), documented medication timing, radiotherapy fields, and records of exposures or events (envenomation, stressful events, infections). Because many factors rely on precise temporal windows (for example drugs within 24 hours, SARS‑CoV‑2 within 3 months, obesity for at least the 5 years before clinical onset), clinicians, hospitals, and medical records custodians will face increased demand to produce dated clinical documentation that aligns with these windows.

Practitioners, that is lawyers, medical advisers, claims agents and treating clinicians, will need to tailor evidence to the SoP’s detailed thresholds. For example, proving a lipid abnormality requires one of the numerical cut‑offs (HDL <1.0 mmol/L, LDL >4.0 mmol/L, total cholesterol >5.5 mmol/L), or evidence of regular administration of lipid‑normalising drugs for previously elevated lipids (s9(4)). Smoking history must be converted into pack‑year calculations or daily cigarettes over specified periods (s9(5)-(6) and Schedule 1 pack‑year definition). Demonstrating second‑hand smoke exposure requires quantified hours in an enclosed space (1,000 and 5,000 hours thresholds). Mental health clinicians and records custodians will be asked to show that a mental disorder was “clinically significant” for at least 5 years (s9(16) and Schedule 1).

Most of the enumerated factors concern medical risk states that are common in the general population (hypertension, diabetes, obesity, abnormal lipids, smoking). That means many claimants may be able to satisfy the "at least one factor" requirement, but only if records exist within the defined time frames. Conversely, claimants without contemporaneous measurements or with incomplete medical records may struggle to satisfy the specific numerical thresholds, even where a clinician would subjectively consider a risk profile present.

Other affected parties include insurers and government budgets insofar as decisions on service connection translate into entitlement payments and healthcare provision. While the instrument itself does not alter compensation formulas, decisions resting on the SoP determine which claimants obtain judgment on causation and thus access to subsequent entitlements under VEA/MRCA frameworks.

Finally, the repeal of the 2016 SoP means affected claimants, practitioners and decision‑makers must be attentive to timing: claims lodged or assessed after commencement will be governed by this instrument and its thresholds rather than the 2016 text (Repeal). That temporal change can alter case strategy, evidence gathering and retroactive expectations for claims in process at the time of repeal.

The instrument primarily creates duties and rights in the administrative sense, orienting how claims for entitlements will be assessed. It does not impose criminal sanctions or private law duties. The key legal duties and rights arising from the SoP are as follows.

Duties of proof and evidentiary duty on claimants. The SoP establishes that before a decision‑maker can conclude, on the balance of probabilities, that ischaemic heart disease is connected with relevant service, at least one enumerated factor must be shown to exist (Factors that must exist, s9). The duty, operationally, falls on the claimant to adduce medical and documentary evidence that at least one factor applied to the person within the relevant temporal framework relative to clinical onset or clinical worsening, and that the factor is related to the person's relevant service (s10(1)). For example, proving lipid abnormalities requires presenting laboratory reports or documented lipid‑lowering therapy. Proving exposure to second‑hand smoke requires evidence of hours of exposure in enclosed spaces. The SoP supplies the thresholds; claimants must meet them with evidence.

Right to have causation assessed according to the SoP. A claimant has the right to have their ischaemic heart disease causation judged against the SoP where the claim falls under VEA s120B or MRCA s339 (Application, s5). The SoP operates as the RMA’s authoritative statement of relevant medical‑scientific factors for causation. If a claimant can satisfy the listed criteria, decision‑makers should find the requisite connection on the balance of probabilities. Conversely, failing to satisfy any factor is a legitimate ground for a finding of no service connection, subject to the overall evidentiary standard.

Duty on decision‑makers to apply linked SoPs where referenced. If a factor in this SoP refers to an injury or disease that is the subject of another SoP, that other SoP applies according to its own terms (s11). Decision‑makers must therefore cross‑check other SoPs and apply their provisions as in force. That is a duty to consult and integrate other authorised RMA statements when factors overlap.

Duty to relate factors to relevant service. Section 10(1) requires that any factor established must be related to the person’s relevant service. This creates a further evidentiary requirement beyond the mere presence of a factor: claimants must show both that the factor existed in the time frames required by s9 and that the factor’s occurrence is causally connected to their relevant service. The instrument does not prescribe the precise method for establishing that relation, leaving it to the decision‑maker’s application of the balance of probabilities standard in light of the evidence.

Scope limits on clinical worsening claims. Section 10(2) limits the use of “clinical worsening” aspects of factors to cases where the ischaemic heart disease was suffered or contracted before or during, but did not arise out of, relevant service. This creates a procedural boundary: if the disease arose out of service, the “clinical worsening” framing does not apply; if it was pre‑existing and service occurred, clinical worsening may be relied on but only where service materially contributed or aggravated the condition.

Rights to administrative review and appeals remain governed by the VEA and MRCA processes, not by the SoP itself. The SoP governs what evidence suffices for causation; procedural rights to review and appeal decisions based on the SoP follow the statutory appeal pathways in the VEA/MRCA regimes.

No criminal or civil penalties within the SoP. The instrument contains no penalty provisions; its role is evidentiary and determinative for entitlements. Enforcement of its criteria occurs through administrative decision‑making on claims, and potential review by review bodies or courts under the enabling Acts.

In short, the key duties are evidentiary and relational: establish at least one enumerated factor in the specified temporal relation to clinical onset or worsening, and show that it relates to relevant service (s9, s10). Rights include the claimant’s entitlement to have causation evaluated against these criteria and the decision‑maker’s duty to apply linked SoPs (s11).

The Statement of Principles itself contains no penal sanctions nor prescriptive enforcement mechanisms beyond its use as an authoritative evidentiary instrument in administrative decision‑making under the VEA and MRCA. The instrument does not amend criminal law, create civil liability, or impose fines. Instead, enforcement is indirect: the SoP’s criteria determine whether a claimant meets the causation threshold required to obtain entitlements under the VEA and MRCA, and administrative decisions will therefore enforce the instrument by granting or denying service connection.

Administrative enforcement mechanisms. The instrument will be enforced through the existing entitlement decision processes under the VEA and MRCA, specifically in relation to claims captured by VEA s120B and MRCA s339 (Application). Decision‑makers in the Department (and any tribunals or review bodies operating under the Acts) will apply the SoP as the RMA’s statement of medical‑scientific factors. A failure by a claimant to establish any of the enumerated factors, or to relate an established factor to relevant service as required by s10, will be a substantive ground for refusal of service connection. That is the primary enforcement pathway: administrative determination of entitlement based on whether the SoP's conditions are met.

Standards of proof and effect on outcomes. The stated standard is the balance of probabilities (s8). The SoP therefore instructs decision‑makers to apply the civil standard ordinarily used in administrative entitlements for causation questions. The standard interacts with the enumerated factors: the presence of an applicable factor, related to service, supports a finding of causation on the balance of probabilities; absence of such a factor means the decision‑maker may lawfully find no connection.

No statutory penalties for false claims are imposed by this instrument. While other provisions of the VEA or general law may criminalise fraud or false statements, this instrument does not itself create those offences or procedural sanctions. The SoP only informs entitlement decisions.

Potential consequence pathways not in the SoP. The instrument’s consequences are indirect and practical: an adverse finding (no service connection) means the claimant will not obtain VEA/MRCA entitlements tied to ischaemic heart disease or to death from ischaemic heart disease. That outcome can affect medical treatment funded under veterans’ entitlements, pension or compensation payments, and ancillary benefits. Those downstream consequences are material, but they are not penalties in the sense of fines or criminal punishment; they are denial of administrative benefits.

Role of other SoPs and cross‑references. Enforcement can also be procedural in the sense that s11 requires application of other SoPs where relevant. This creates a layered enforcement model: if a factor references another disease covered by another SoP, decision‑makers must apply that SoP’s factors when evaluating the claim, and thereby enforce interlocking SoP criteria.

Recordkeeping and evidentiary implications. Because the instrument operationalises many criteria through numerical thresholds and tight temporal windows (for example drugs taken within 24 hours, SARS‑CoV‑2 within 3 months, obesity for at least 5 years), enforcement through administrative decision‑making will require documentary proof. The practical enforcement effect is that claimants are incentivised to produce medical records, laboratory results, radiotherapy plans, medication charts and dated evidence of exposure events; absence of such records will likely lead to adverse decisions.

In sum, the SoP enforces its criteria through the entitlement determination process under the VEA and MRCA. It does not introduce new statutory penalties, but it creates binding administrative gates that determine whether claimants receive statutory benefits.

This SoP operates within and interacts with the statutory frameworks of the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). It is made under subsection 196B(3) of the VEA (Authority, s3), and it applies specifically to claims to which VEA s120B and MRCA s339 apply (Application, s5). The instrument therefore functions as an RMA determination authorised by the VEA, and its legal effect is confined to shaping determinations under those Acts.

Interplay with the VEA and MRCA decision processes. The SoP provides the medical‑scientific factors that decision‑makers must consider when assessing causation under the VEA and MRCA claims provisions. It does not modify entitlements, compensation formulas or procedural appeal rights established by those statutes. Instead, it informs the factual question of whether a person’s ischaemic heart disease is connected with their relevant service, a question that is decisive in many VEA/MRCA entitlement determinations.

Cross‑reference to other Statements of Principles. Section 11 explicitly incorporates cross‑application: if a factor in this SoP refers to an injury or disease covered by another SoP determined under subsection 196B(3) of the VEA, then the factors in that other SoP apply as in force from time to time. That mechanism integrates the RMA’s family of SoPs. Practically, where a factor refers to, for example, chronic kidney disease, mental health disorders, or another specified disease that has its own SoP, decision‑makers must consult and apply the other SoP’s criteria. This interdependence requires cross‑referencing and coherent application across RMA instruments.

ICD coding and clinical classification. The instrument notes that while ischaemic heart disease corresponds to ICD‑10‑AM codes I20-I25, the statutory meaning for the SoP is the textual definition in subsection 7(2) (s7(3)-(4)). A reference to an ICD‑10‑AM code is defined by reference to the Tenth Edition, effective 1 July 2017 (s7(5)). This establishes that ICD coding is a supporting classificatory tool, but the RMA’s textual definition controls legal meaning. In disputes where ICD coding and textual description diverge, decision‑makers should prioritise the SoP text.

Interaction with general administrative law. The SoP is an administrative instrument with evidentiary effect; decisions applying the SoP will be reviewable under the administrative review mechanisms provided by the VEA and MRCA and, ultimately, by judicial review for jurisdictional error or failure to apply the SoP where required. The instrument itself does not spell out review rights, but those rights remain governed by the enabling Acts and general administrative law.

Overlap with other federal or state laws. The SoP’s definitions and thresholds (for example, definitions of organophosphorus esters, hypertensive emergency, or occupational exposures) may overlap with statutory definitions in other contexts, such as workers’ compensation or public health regulations, but the SoP’s application is limited to VEA/MRCA claims. It does not preclude other legal processes. For example, an exposure to organophosphate pesticide relevant to the SoP could also give rise to a workers’ compensation claim under state law; the SoP does not alter that separate legal pathway.

Data and privacy interactions. The SoP’s evidentiary requirements increase the practical need to obtain and disclose medical records, military service records, and potentially other personal data. The instrument does not specify privacy mechanisms; those remain governed by existing privacy and records legislation and departmental policies. Claimants and practitioners must therefore manage access to records in compliance with privacy laws while assembling evidence to meet the SoP thresholds.

Effect of repeal of earlier SoP. The instrument repeals the 2016 ischaemic heart disease SoP (Repeal). That change interacts with claims assessed under the earlier SoP: from commencement (25 March 2025), assessments should proceed under the 2025 SoP. Transition issues such as claims lodged but not yet decided at commencement will be governed by the statutory process for applying the relevant instrument as in force at the time of decision; practitioners should be alert to how decision‑makers apply the new thresholds to ongoing claims.

In summary, the SoP is a specialised, RMA‑authorised evidentiary instrument that integrates with the VEA/MRCA claims processes, references other SoPs where appropriate, uses ICD coding as a classificatory aid, and interacts practically with privacy and records laws, while remaining confined to the entitlement domain of the VEA and MRCA.

The instrument itself contains a brief and explicit amendment history comprised of repeal and replacement mechanics. It expressly repeals the earlier Statement of Principles concerning ischaemic heart disease No. 2 of 2016, Federal Register of Legislation No. F2016L00003, which was originally made under subsections 196B(3) and (8) of the VEA (Repeal). The current instrument is identified as No. 28 of 2025, dated 18 February 2025, and commences on 25 March 2025 (Name, Commencement, Repeal).

What is recorded in the text. The instrument records the fact of repeal (s4) and the authority under which the new SoP is made (s3, subsection 196B(3) VEA). No other amendments to existing legislation are made by this instrument; it is purely a replacement SoP. The Schedule of contents lists discrete headings and a dictionary, which implement the new definitions and thresholds. The instrument therefore serves as a consolidated update rather than an incremental amendment to the 2016 SoP.

Implications for prior SoP. The repeal clause means that, from the commencement date, decisions that would otherwise have used the 2016 SoP must instead apply the 2025 SoP. The text does not state transitional provisions for claims in progress, or savings for decisions already made under the 2016 instrument. The presence of an explicit repeal without transitional text requires practitioners and decision‑makers to determine whether a claim pending at commencement is to be assessed under the new SoP or the prior one, as governed by the administrative law principles and any directions in the VEA/MRCA about the application of new determinations. The instrument’s silence on transitional savings is therefore a point of administrative significance.

Frequency and style of RMA updates. While the instrument does not provide a history beyond the 2016 statement it replaces, RMA SoPs are comprehensively revised when medical‑scientific evidence evolves. This instrument forms the 2025 authoritative statement for ischaemic heart disease. Practitioners should expect the RMA to issue future SoPs or amendments as evidence changes, and should monitor the Federal Register of Legislation for any subsequent revisions.

No amendments to the definitions beyond Schedule 1 in this instrument. All definitional changes and new thresholds are contained in the Schedule 1 dictionary that accompanies this SoP. The Schedule supplies operational definitions (for example, BMI, pack‑year, category 1A/1B stressor) that implement the SoP’s criteria. The instrument does not amend other statutes or SoPs directly; it relies on s11 to interact with other SoPs, which are maintained as separate instruments and may themselves be updated independently.

Administrative effect rather than legislative amendment. It is important to note that this instrument operates within the delegated legislative and administrative framework: it is an RMA determination made under statutory power, not a statute that amends primary legislation. Its amendment history is therefore limited to the RMA’s replacement and repeal of prior SoPs, as occurred here.

In summary, the documented amendment history in the instrument is the replacement of the 2016 SoP with the 2025 SoP, effective 25 March 2025. There are no other amendments recorded in the text.

The instrument itself does not contain any litigation history. It is a Statement of Principles issued by the Repatriation Medical Authority and the text does not reference any court or tribunal decisions, appeals, or litigation involving the 2016 or the new 2025 ischaemic heart disease SoP (the instrument’s contents and Schedule do not name any cases). Therefore, no cases are cited within the instrument as shaping the criteria it contains.

Implications for practitioners. The absence of litigation history in the instrument does not mean that decisions applying earlier SoPs have not been litigated, only that this instrument does not itself record any judicial commentary. Practitioners should be aware that decisions under the VEA and MRCA applying SoPs may be subject to merits review within the statutory review framework and, potentially, judicial review if there are grounds for jurisdictional error or failure to apply the SoP in an appropriate manner. This instrument does not change that procedural reality; it simply supplies the RMA’s updated medical‑scientific factors.

Areas where litigation might emerge. The instrument creates numerous precise thresholds and temporal windows that may generate legal argument in the application of the SoP to specific fact patterns. Potential litigation points could include: whether a claimant’s available evidence meets a numerical cut‑off (for example LDL >4.0 mmol/L); whether a recorded exposure falls within the relevant temporal window (for example SARS‑CoV‑2 within 3 months); whether a factor is properly “related to the person’s relevant service” under s10(1); and how to treat the “clinical worsening” aspects under s10(2) where disease pre‑existed service. Any of these interpretive issues could be the subject of administrative appeals or judicial review, but the instrument itself does not cite precedent on these points.

Recommendation for practitioners. Because the SoP does not supply case law, practitioners should collect robust fact evidence and be prepared to argue how the SoP’s thresholds apply to the claimant’s record. Where novel interpretive issues arise, record suitable grounds for review and consider developing targeted legal points for merits or judicial review if a decision turns on a contested application of the SoP. However, any litigation history, case law development or administrative determinations that interpret this 2025 SoP will be external to the instrument and should be tracked separately through tribunal and court reporting once cases begin to be decided under the new SoP.

In short, the instrument contains no litigation history. Its interpretive and application issues will generate case law only as decision‑makers and claimants engage the new thresholds in the VEA/MRCA claims process.

The instrument’s detail creates multiple practical pitfalls for claimants, clinicians and advisers. Below are concrete "gotchas" drawn directly from the SoP text that commonly trip up claims unless addressed proactively.

1. The "at least one factor" gate. Section 9 states that at least one enumerated factor must exist for connection to be established. That is a conjunctive procedural gate: in many contexts claimants or clinicians may assume that a general clinical picture of cardiovascular risk suffices, but the SoP requires a specific listed factor with defined thresholds or time windows. Failure to present evidence for any listed factor is a likely reason for refusal.

2. Numeric laboratory cut‑offs. Lipid criteria use explicit numeric values: HDL <1.0 mmol/L, LDL >4.0 mmol/L, total cholesterol >5.5 mmol/L, or the regular administration of lipid‑normalising drugs for previously elevated levels (s9(4)). Many historic lipid reports may not exactly match these cut‑offs; borderline reports need careful interpretation. Relying on general statements of “dyslipidaemia” without records is risky.

3. Time‑sensitive medication windows. Numerous items specify very short windows relative to clinical onset: a long list of drugs must have been taken within the 24 hours before onset or worsening (s9(18)); antipsychotic within 24 hours (s9(19)); several other triggers are within 24 hours (stressors category 1A/1B) or 12 hours (acute severe stressful event, acute hypersensitivity reaction). Documentation must show exact or closely proximate timing. Claims relying on imprecise timing are vulnerable.

4. Obesity and duration requirement. Being obese must have been present for at least the five years before clinical onset/worsening (s9(3)). If a claimant demonstrates current BMI ≥30 but lacks historical records showing sustained obesity for five years, the criterion may not be satisfied. The Schedule defines being obese by BMI or waist circumference (Schedule 1), so waist circumference records are an alternative but must meet the thresholds and duration.

5. Smoking and pack‑year calculations. Smoking criteria differentiate between ongoing smoking and smoking cessation, with specific pack‑year thresholds and temporal limits (s9(5)-(6), Schedule 1). The SoP uses epidemiological pack‑year calculations and gives explicit examples. Errors in calculation or in converting alternate tobacco products to equivalents (Schedule 1 notes 7,300 grams etc.) can lead to misapplication.

6. Second‑hand smoke quantified in hours. The SoP requires quantification of hours of exposure in enclosed spaces (1,000 and 5,000 hours thresholds) and applies different windows depending on whether exposure ceased (s9(7)-(8)). Individuals seldom have contemporaneous records of second‑hand smoke hours, making this difficult to prove.

7. Clinical worsening restricted to pre‑existing disease not arising out of service. Section 10(2) restricts the "clinical worsening" application to cases where the ischaemic heart disease was suffered or contracted before or during but did not arise out of service. Determining whether disease "arose out of" service versus being pre‑existing may itself be contested and is directly relevant to whether the clinical worsening aspects of the SoP can be invoked.

8. Cross‑SoP dependencies. If a listed factor refers to another disease covered by a different SoP, that other SoP applies (s11). Practitioners must identify and produce evidence under the other SoP’s criteria. Missing this step can lead to oversight of a controlling SoP.

9. Examples versus exhaustive lists. The Schedule sometimes contains examples (for example hypercoagulable states) rather than exhaustive lists. Decision‑makers may treat unlisted but medically analogous conditions inconsistently, so where a condition is not named expressly, contemporaneous expert evidence explaining equivalence will be crucial.

10. Envenomation, ambient temperature, and other unusual triggers. The SoP includes unusual but tightly timed triggers, such as envenomation within 24 hours, ambient temperatures ≥38°C or ≤0°C for at least 6 hours within 1 week of onset, and organophosphorus poisoning within 1 week (s9(27)-(29), (36)). These require documentary or witness evidence of exposure timing and intensity that is often not collected.

11. Infectious disease windows. SARS‑CoV‑2 within 3 months and influenza or lower respiratory tract infection within 30 days are included (s9(33)-(34)). For SARS‑CoV‑2, reliance on test records and timing is critical; serology alone may not establish the required window.

12. Mental health duration. The requirement for a clinically significant mental health disorder for at least 5 years prior to onset (s9(16)) can be difficult to demonstrate if the disorder was not actively managed or recorded in medical records, because the Schedule clarifies that "warranting ongoing management" does not require that management was received. Evidence must show the disorder’s severity, not merely a diagnostic label.

13. Terminal event definition for death claims. Death from ischaemic heart disease includes death from a terminal event contributed to by ischaemic heart disease and the Schedule defines several terminal events (pneumonia, cardiac arrest, circulatory failure, cessation of brain function) (Death from ischaemic heart disease, s7(6) and Schedule 1). For death claims, establishing the chain between ischaemic heart disease and the terminal event requires careful cause‑of‑death documentation.

14. Repeal and commencement timing. Because the 2016 SoP is repealed (s4) and the new instrument commences on 25 March 2025, parties must be alert to which instrument governs claims at different procedural stages. The SoP itself does not include transitional provisions, which can create administrative uncertainty for claims mid‑process.

15. Reliance on precise measurements such as METs. Physical capability is framed by MET thresholds (for example inability to undertake activity >3 METs for at least 5 years) and the Schedule explains what 1 MET and 3-4 METs practically mean. Claimants will need physiotherapy or activity records to show MET limitations over time.

Each of these items is a concrete evidentiary or timing pitfall. The remedy is preparation: obtain dated, contemporaneous medical and service records, convert histories into the SoP’s units (pack‑years, hours of exposure, METs), and where records are incomplete, obtain expert evidence to explain and relate clinical history to the SoP thresholds.

Compliance is about assembling the right evidence to show that at least one of the SoP’s listed factors both existed and was related to the person’s relevant service, within the SoP’s specified time frames. Below is a practical, itemised compliance checklist for claimants, clinicians, advisers and decision‑makers, referencing the instrument’s key requirements.

1. Confirm applicability and timing.

• Verify that the claim falls under VEA s120B or MRCA s339 (Application, s5).
• Note the SoP commencement date, 25 March 2025, and apply the 2025 instrument to claims decided on or after that date (Commencement, s2). Determine whether any pending claim should be assessed under the new SoP consistent with administrative practice.

2. Identify the relevant clinical onset or clinical worsening date.

• The SoP’s temporal windows pivot on “clinical onset or clinical worsening.” Establish a clear, dated clinical onset or documented clinical worsening event (hospital admission, myocardial infarction date, diagnosis notes). Time windows for many factors are relative to that date (for example medications within 24 hours, obesity for at least 5 years).

3. Establish at least one enumerated factor (s9).

• For chronic risk factors, obtain longitudinal records:
  • Hypertension: BP records or antihypertensive prescriptions showing diagnosis before onset.
  • Diabetes mellitus: diagnostic records, HbA1c, medications.
  • Obesity for at least 5 years: serial BMI or waist circumference measurements; if only weight/height at intervals exist, compute BMI using Schedule 1 BMI formula.
  • Persistently abnormal lipids: produce laboratory lipid panels with HDL, LDL, total cholesterol; if on lipid‑normalising therapy, provide prescription records showing regular administration for previously elevated lipids (s9(4)).
  • Chronic kidney disease: GFR values <45 mL/min/1.73 m2 over at least 3 months, albumin:creatinine ratio ≥3 mg/mmol for at least 3 months, renal biopsy/imaging, or records of kidney transplant (s9(11)).
  • Clinically significant mental health disorder: psychiatric records showing severity warranting ongoing management for at least 5 years (s9(16), Schedule 1 definition).
• For trigger events and exposures, compile precise dated evidence:
  • Drug exposures: medication charts, pharmacy records or hospital notes indicating ingestion within the specified 24‑hour or 7‑day windows for listed drugs (s9(18), s9(20), s9(21), s9(22)).
  • Smoking: detailed smoking history to calculate pack‑years per Schedule 1; if cessation occurred, align cessation date with SoP windows (s9(5)-(6)).
  • Second‑hand smoke: affidavits, workplace records, service accommodation records or other contemporaneous documentation quantifying hours in enclosed spaces exposed to exhaled smoke (s9(7)-(8)).
  • Physical activity thresholds (METs): clinical assessments, functional capacity tests or occupational health records documenting inability to undertake >3 METs for at least 5 years (s9(9)).
  • Environmental exposures: records of ambient temperature exposure (for example deployment records showing sustained exposure to ≥38°C or ≤0°C for 6 hours within a week), documented envenomation events, or organophosphate exposure records (s9(27), (29), (36)).
  • Infection events: SARS‑CoV‑2 test results, influenza diagnosis, or lower respiratory tract infection records with dates aligning to 3 months or 30 days windows respectively (s9(33)-(34)).
  • Stressors: service records, incident reports, witness statements, or military citations establishing category 1A/1B stressors or other acute severe stressful events within the stated windows (Schedule 1 definitions and s9(24)-(26)).
  • Medical procedures: radiotherapy plans showing the heart in the radiation field, catheterisation reports within 30 days before MI or unstable angina, documentation of infective endocarditis, syphilis with coronary involvement, or vasculitis diagnoses at onset (s9(12)-(15), (17), (23)).
• Where conditions are not directly recorded but plausibly satisfy a criterion, obtain expert clinical opinion linking the available records to the SoP threshold.

4. Demonstrate relation to relevant service (s10).

• Produce service records showing the timing and nature of relevant service, including deployments, duties, exposures, and any incident reports that connect a listed factor to the person’s time in service.
• For “clinical worsening” claims, show disease pre‑existed or was contracted before/during service and did not arise out of service, then demonstrate how service materially contributed to or aggravated the condition (s10(2)). This will require a combination of medical and service records and, where necessary, expert medical opinion tying the timing and mechanism of aggravation to service events.

5. Cross‑check other SoPs where a factor references another disease (s11).

• If you rely on a factor that itself relates to another disease covered by an SoP (for example chronic kidney disease, or a specific vasculitis), identify and comply with that SoP’s requirements. Extract and present evidence satisfying both SoPs as necessary.

6. Documentation standards.

• Use contemporaneous, dated records where possible: hospital discharge summaries, ECGs, cardiac enzyme results, catheterisation reports, radiotherapy plans, GP records, pharmacy dispensing records, pathology and imaging reports, occupational health and deployment records, and witness statements for stressors or exposures.
• Where contemporaneous records are incomplete, secure treating clinician statements that reconstruct history with rationales, and obtain explanatory expert reports addressing any evidentiary gaps vis‑à‑vis the SoP’s strict thresholds.

7. Measurement and unit conversions.

• Convert smoking history into pack‑years per Schedule 1 methodology. For alternative tobacco products, apply the conversion notes (Schedule 1).
• Calculate BMI using the Schedule 1 formula and ensure waist circumference measurements meet the gender thresholds where used.
• Translate physical activity into METs where required, referencing the Schedule’s examples (for example 3-4 METs = walking at 5 km/h).

8. Anticipate challenges and prepare to rebut.

• Expect decision‑makers to scrutinise timing for short windows (24 hours, 12 hours, 1 week, 30 days, 3 months). Provide dated evidence or admissible witness statements.
• For second‑hand smoke and ambient temperature exposures, documentation is often scarce; prepare sworn statements, duty rosters, records of accommodation or transportation that corroborate exposure durations.

9. Procedural steps for submissions.

• Clearly map each piece of evidence to the specific SoP clause it supports in the claimant submission.
• Provide a chronology that aligns clinical onset/worsening, the asserted factor(s), and relevant service events to satisfy s10(1).
• If relying on multiple potential factors, list them and indicate which is relied on primarily for the causation finding.

10. For decision‑makers.

• Apply the SoP’s textual definition of ischaemic heart disease in s7(2) and treat ICD‑10‑AM coding as auxiliary (s7(3)-(5)).
• Where a factor references another SoP, apply that SoP as current (s11).
• Apply the balance of probabilities standard (s8) while ensuring that an enumerated factor is present and related to the person’s relevant service (s9, s10).

Following these steps aligns evidence collection and presentation with the instrument’s concrete criteria. The SoP’s numerous numeric thresholds and precise time windows mean that successful compliance is documentary and chronological: show the factor existed in the required form and time, and show a connection to relevant service. Where records are incomplete, high‑quality expert explanation will be necessary to bridge evidentiary gaps.