Statement of Principles concerning ischaemic heart disease (Reasonable Hypothesis) (No. 27 of 2025)

The SOP rests on a small set of core legal-medical concepts that structure how a claim will be assessed.

• Ischaemic heart disease: The instrument defines IHD as "a cardiac disease in which inadequate coronary blood supply to part of the heart leads to infarction or periodic ischaemia" and expressly includes myocardial infarction (STEMI and NSTEMI), angina pectoris (including unstable and Prinzmetal angina), ischaemic cardiomyopathy and acute coronary syndrome while excluding coronary artery disease without ischaemia and MI due to generalised hypoxia, vascular shock or cardiac arrest (s7(2)). The SOP notes the usual ICD-10-AM codes that attract to IHD but makes clear the statutory meaning is the textual definition in s7(2).
• Reasonable hypothesis: The SOP is expressed as the evidentiary threshold required to raise a reasonable hypothesis connecting IHD or death from IHD with relevant service. It operationalises this threshold by listing specific factors; the instrument states that at least one of the factors in section 9 must minimally exist to say that a reasonable hypothesis has been raised (s9).
• Relevant service: The SOP applies only where the IHD claim relates to 'relevant service' as defined in the Schedule (which includes operational, peacekeeping, hazardous, British nuclear test defence service under the VEA and warlike or non-warlike service under the MRCA). The existence of any factor must be related to the relevant service rendered by the person (s10(1); Schedule definition of relevant service).
• Temporal and quantitative thresholds: For each factor, the SOP typically includes quantitative thresholds (for example lipid levels, pack-years, BMI) and temporal windows (for example exposures within 24 hours, 1 week, 5 years, 25 years). The instrument frequently distinguishes ongoing exposure, cessation and lag periods (for example smoking cessation windows in s9(4)-(6), Otto fuel II exposures with first exposure at least 5 years before clinical onset and up to 25 years after cessation in s9(22)).
• Clinical onset and clinical worsening: The instrument repeatedly ties factors to either clinical onset or clinical worsening events. Section 10(2) limits the application of clinical worsening factors to cases where the IHD was suffered or contracted before or during, but did not arise out of, the person’s relevant service , that is, the “clinical worsening” route applies only for material contribution/aggravation of pre-existing disease.
• Cross-reference to other SOPs and diseases: If a factor refers to an injury or disease covered by another SOP, that other SOP applies as in force from time to time (s11). The Schedule contains definitions used throughout, such as BMI, pack-year, chronically polluted air and terminal event.

These concepts structure the evidence that claimants must present and the assessments decision-makers must make. In short, the SOP transforms a causation inquiry into a checklist of medically-defined factors each with required measurements and timing, plus the additional legal requirement that the particular factor be related to the person’s relevant service (s9; s10).

Primary affected parties

• Veterans and former members of the Australian Defence Force, and members who rendered peacekeeping or other service falling within the SOP’s definition of relevant service, who lodge claims under section 120A of the VEA or section 338 of the MRCA (s5; Schedule “relevant service”).
• Claimants alleging death from ischaemic heart disease, because the instrument explicitly extends to "death from a terminal event or condition that was contributed to by the person's ischaemic heart disease" (s7(3)).
• The Repatriation Commission and administrators adjudicating VEA and MRCA claims, who will apply the SOP as the RMA's medical-scientific determination for the reasonable hypothesis threshold (s3; s8).

Secondary affected parties

• Medical practitioners and experts preparing opinions and reports for claim purposes. The SOP imposes specific laboratory thresholds, exposure metrics, and temporal requirements that clinicians and experts must address when advising a claimant or the Department.
• Legal representatives and advocates who prepare submissions for claims before the Repatriation Commission or the Veterans’ Review Board. The SOP dictates which kinds of evidence and temporal specificity are necessary to meet the minimal "reasonable hypothesis" threshold.
• Employers and record-keepers from a veteran’s service period who may be asked to supply service records, exposure logs, shift rosters, radiotherapy records, dosimetry and environmental monitoring data where relevant (for items such as night shift work, radiotherapy exposures, Otto fuel II or herbicide exposures).
• Government departments that process claims, which will face the administrative task of verifying exposure durations, laboratory results, and medical histories against the enumerated thresholds, and the budgetary consequences if more claims meet the reasonable hypothesis threshold.

Who does not get affected by this instrument directly

• Persons who do not have relevant service as defined in the Schedule are outside the SOP’s application (s5).
• Conditions excluded from the definition of IHD (for example coronary artery disease without ischaemia and MI due to generalised hypoxia, vascular shock, or cardiac arrest) are not raised by this SOP (s7(2)(3)).

Timing sensitivity and cohorts

The SOP contains many temporal thresholds that map into who can plausibly meet the requirements. Long-lag exposures with long look-back windows (for example radiation dosimetry, Otto fuel II and herbicide/TCDD-contaminated chemical agents with first exposure at least 5 years before clinical onset and up to 25 years after cessation where exposure ceased, s9(15), s9(24), s9(26)) produce potential claim cohorts with service-related exposures many years prior to clinical onset. Short-lag, proximate triggering events (for example acute stressful events within 24-48 hours, illicit drug use within 24 hours, infection with SARS-CoV-2 within 3 months) create a different cohort of acute-onset or acute-worsening cases.

Information asymmetries and evidentiary impacts

Several factors will be straightforward to verify in clinical records (hypertension, diabetes, recorded lipid levels, radiotherapy). Others will be harder to prove (hours of second-hand smoke exposure in enclosed spaces, average vegetable/fruit intake of 100 g/day over five years, cumulative hours of exposure to Otto fuel II). Where the SOP requires specific quantitative or durational measures, the burden of producing supporting records or credible contemporaneous evidence falls on claimants and their representatives.

This instrument sets out medical-scientific criteria; it does not itself impose criminal sanctions, regulatory duties on private parties, or novel statutory rights. Its operative duties and rights arise in how administrative decision-makers and claimants must act when adjudicating or making claims under the VEA and MRCA.

Duties for administrative decision-makers

• Apply the RMA’s Statement of Principles when assessing whether a reasonable hypothesis has been raised connecting IHD or death from IHD to relevant service. The instrument explicitly sets out that "at least one of the following factors must as a minimum exist" before a reasonable hypothesis is raised (s9). Decision-makers therefore carry the duty to check for the presence of any listed factor, including whether it satisfies the SOP’s quantitative and temporal thresholds.
• Where a factor refers to an injury or disease with its own SOP, apply that other SOP in accordance with its terms as in force (s11). Decision-makers must make cross-references to other medical SOPs rather than treating referenced conditions generically.
• Interpret and apply the definitions in Schedule 1 when assessing claims, because the instrument requires specific operational definitions for BMI, pack-year, chronically polluted air, category 1A/1B stressors and others (Schedule 1).

Duties for claimants (and their advisers)

• Establish that at least one of the SOP factors existed in relation to them, and that that factor was related to their relevant service (s9; s10(1)). The SOP provides precise thresholds and time windows; claimants bear the practical duty to produce evidence matching those thresholds where possible.
• For claims premised on clinical worsening, show that the IHD was suffered or contracted before or during (but did not arise out of) the person's relevant service, because clinical worsening factors apply only to material contribution or aggravation in that limited context (s10(2)). That requires documentary or expert confirmation of the disease timeline relative to service.

Rights implicit in the administrative process

• Claimants retain the statutory avenues under the VEA and MRCA to make claims and seek review; the SOP is the RMA’s medical determination that informs whether the "reasonable hypothesis" stage is met. The instrument itself states it "applies to a claim to which section 120A of the VEA or section 338 of the MRCA applies" (s5), which signals its role in those statutory claim processes.
• Where a factor refers to another SOP-disease, affected persons have the right to have that other SOP applied as in force at the time (s11).

What the SOP does not do

• It does not itself create compensation entitlements, procedural rights, or payment obligations; rather, it is an evidentiary-medical instrument that affects whether the statutory threshold of a reasonable hypothesis is met in claims processed under the VEA and MRCA.
• It does not define how decision-makers must weigh multiple factors when more than one exists; it requires only that at least one factor must exist before a reasonable hypothesis can be said to be raised (s9), leaving the further legal assessment steps to the governing statutes and adjudicators.

Precision obligations

The instrument places precision obligations on both sides. For example, where the SOP requires "a serum high density lipoprotein cholesterol level less than 1.0 mmol/L" or "a serum low density lipoprotein cholesterol level greater than 4.0 mmol/L" (s9(4)(a)-(b)), decision-makers will look for recorded laboratory values meeting these thresholds. Where a factor involves exposure hours, the instrument’s use of precise numbers (for example 1,000 hours, 5,000 hours) imposes the requirement that evidence address those numeric thresholds or provide credible reconstruction.

This instrument does not create criminal offences or civil penalties. It is an administrative medical determination under subsection 196B(2) of the VEA (s3). The SOP’s enforcement and operational effect are administrative and evidentiary: it prescribes the RMA’s medical grounds for raising a reasonable hypothesis in claims considered under the VEA and MRCA (s8).

Key enforcement and remedial mechanisms

• Administrative application to claims: The SOP operates through claims decision-making processes under section 120A of the VEA and section 338 of the MRCA (s5). The RMA’s SOP is a determinative input into an administrative decision whether a reasonable hypothesis is raised; the SOP’s factors and thresholds are the basis upon which adjudicators accept or reject the link between service and disease.
• Cross-application with other SOPs: Where a listed factor references an injury or disease covered by another SOP, that other SOP applies "in accordance with the terms of that Statement of Principles as in force from time to time" (s11). The system of SOPs thereby enforces consistency across related medical conditions by requiring decision-makers to follow whatever the RMA has determined for those conditions.

What is not enforced by this instrument

• The SOP does not itself impose sanctions on claimants who provide false information. Any penalty for false statements would arise under separate legislation governing claims, or under general criminal or civil laws outside this SOP; the instrument is silent on penal consequences.
• The SOP does not create statutory licensing, registration, or reporting obligations for medical practitioners. It sets medical thresholds that experts will address in evidence, but it does not prescribe duties or disciplinary consequences for clinicians.

Practical enforcement implications

• The practical enforcement burden falls on the administrative machinery that processes claims: verifying that a listed factor existed, that the required laboratory or exposure thresholds are met, that temporal criteria are satisfied, and that the factor is related to relevant service (s9; s10). That enforcement is primarily documentary and expert-evidence driven rather than punitive.
• Because the SOP enumerates discrete numerical thresholds and time windows, administrative enforcement becomes an exercise in verification of records (laboratory, radiotherapy/dosimetry, occupational exposure, service records, medical histories), and where documentary evidence is lacking, reliance on expert opinion to reconstruct exposures or interpret records.

Statutory context

• The OPC acts under subsection 196B(2) of the VEA (s3). The instrument expressly applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (s5). Thus the SOP is an administrative tool used within the statutory frameworks of the VEA and MRCA to establish whether a reasonable hypothesis exists that IHD is connected to relevant service.
• The Schedule cross-references and relies on definitions from the VEA and MRCA context, for example MRCA and VEA are defined in the Schedule (Schedule 1, definitions).

Interplay with other Statements of Principles

• The instrument instructs that where a factor refers to an injury or disease covered by another SOP, that other SOP applies according to its terms (s11). This creates a networked interaction among SOPs; for example, if a factor lists chronic kidney disease and there is a separate SOP for chronic kidney disease, the claimant and decision-maker must apply that other SOP’s terms as currently in force.

Medical classification systems

• The SOP notes that while ischaemic heart disease attracts particular ICD‑10‑AM codes (I20-I25), "in applying this Statement of Principles the meaning of ischaemic heart disease is that given in subsection (2)" (s7(4)). The instrument therefore uses ICD coding as a cross-reference but not as the controlling legal definition. It also references the specific edition and effective date of the ICD-10-AM used (Tenth Edition, effective 1 July 2017) (s7(5)).

Overlap with occupational exposure and environmental laws

• The SOP lists exposures such as Otto fuel II, phenoxy acid herbicides (2,4-D and 2,4,5-T), TCDD-contaminated chemical agents, inhalation of polluted air and chronically polluted air (s9, Schedule). Those exposures may also be relevant under other regulatory regimes (for example workplace safety or environmental law), but the SOP itself deals only with their relevance to causation in VEA/MRCA claims. The SOP defines how to measure those exposures for claims purposes, for example by specifying hours and lag periods for Otto fuel II and herbicide exposures (s9(22), s9(24)) and defining chronically polluted air and polluted air thresholds in the Schedule.
• Where the SOP requires cumulative equivalent dose of ionising radiation to the heart, the Schedule defines cumulative equivalent dose and explicitly excludes normal background radiation while including therapeutic radiation, diagnostic radiation, cosmic radiation at high altitude, occupation-related sources, and nuclear explosions/accidents (Schedule definitions). That definitional choice affects interplay with regulatory regimes that might count background radiation differently.

Interaction with evidentiary law and administrative processes

• The SOP does not itself set evidentiary rules for admissibility under administrative law or tribunal procedure; it sets medical thresholds that evidence must meet to raise a reasonable hypothesis. The statutory decision-making and review processes under the VEA and MRCA will determine admissibility, weight, and process. The SOP therefore interacts functionally with administrative law principles , by defining the medical criteria that must be met , but procedural and evidentiary rules will be governed by the parent statutes and their administrative practice.

Limitations on cross-application

• The SOP excludes certain clinical entities from the definition of ischaemic heart disease (for example coronary artery disease without ischaemia, myocardial infarction due to global hypoxia) (s7(2)(3)). These exclusions limit overlap with other diagnostic categories that might otherwise be argued to fall within IHD for claims purposes.

This instrument contains its own immediate amendment history within the text. Key recorded events are:

• Determination and date: The Statement of Principles is dated 18 February 2025 and signed by the Chairperson on behalf of the Repatriation Medical Authority (front matter). The instrument commences on 25 March 2025 (s2).
• Repeal of previous SOP: The instrument expressly repeals the Statement of Principles concerning ischaemic heart disease No. 1 of 2016, Federal Register of Legislation No. F2016L00001, which was previously made under subsections 196B(2) and (8) of the VEA (s4). The text does not include the operative contents of the 2016 instrument, but the repeal indicates replacement of the earlier RMA determination by this instrument.
• No further amendment notes: The instrument as provided does not include any other amendment entries, transitional provisions, or staged commencement provisions beyond the commencement date set out in s2.

Interpreting the available amendment data

• The explicit repeal of the 2016 SOP signals that from the commencement date the 2016 text no longer applies; decision-makers must apply the new SOP in its place for relevant claims arising on or after commencement (s2; s4).
• The instrument contains a saving of cross-reference effect for other SOPs in s11, but it does not record whether the repeal produces any transitional treatment for claims ongoing against the date of repeal. The instrument itself is silent on transitional cases; practitioners should therefore check the procedural rules or administrative guidance of the relevant decision-maker (Repatriation Commission, MRCA administrators) for how ongoing claims straddling the repeal are to be handled.

What the instrument does not record about amendments

• The instrument does not list previous drafts, consultations, or explanatory memoranda in its text. It does not contain a schedule of historical amendments beyond the single repeal statement. If legislative history beyond the instrument is required, users will need to consult external legislative records or the Federal Register of Legislation entries for the 2016 SOP and for any administrative guidance issued by the RMA.

The provided instrument contains no cases, judicial decisions or litigation records. It is a statutory administrative determination and the text includes no references to litigation, appellate decisions or case law.

Practical implications

• The absence of litigation references is consistent with the SOP being a current administrative medical determination. The instrument itself is not a judicial pronouncement, but an RMA determination under s196B(2) of the VEA that will be used administratively to assess claims.
• While the instrument contains no litigation history, decisions that apply this SOP in administrative determinations may later be the subject of internal reviews or merits review, and potentially judicial review proceedings in due course. Those future proceedings, if they occur, and any case law that arises will be recorded and published outside this instrument. The instrument itself provides no name of a test case or precedent to consult.

What practitioners should do

• Treat the SOP as the operative RMA medical determination for reasonable hypothesis assessments from its commencement date. Absent any litigation citations in the text, do not assume that there are judicially-formed limits on how the instrument will be applied. Instead, prepare evidence and arguments that align with the text and definitions of the SOP.
• If a lawyer or adviser needs to know whether particular applications of the SOP have been tested in tribunal or court, they will need to search administrative decisions, the Veterans’ Review Board, the Administrative Appeals Tribunal and judicial databases for decisions that reference Statement of Principles concerning ischaemic heart disease (No. 27 of 2025) after its commencement.

The SOP contains numerous precise thresholds, temporal windows and definitional choices that create practical evidentiary and procedural pitfalls. The following are concrete "gotchas" that frequently trip up claimants, advisers, and decision-makers.

1. Minimum of one factor rule

• The instrument requires "at least one of the following factors must as a minimum exist" to raise a reasonable hypothesis (s9). That is a necessary but not sufficient step in the statutory claims process. Showing a single factor exists is the SOP threshold; further statutory causation and entitlement criteria remain in the VEA and MRCA frameworks.

2. Relationship to relevant service must be shown

• The SOP repeatedly states that the existence of any factor must be related to relevant service (s10(1)). A factor alone, even if present, does not suffice unless the claimant links that factor to relevant service; for example, a veteran with hypertension unrelated to service would not meet the SOP unless the hypertension is shown to have been related to the veteran’s relevant service.

3. Clinical worsening limitations

• Clinical worsening aspects apply "only to material contribution to, or aggravation of, ischaemic heart disease where the person's ischaemic heart disease was suffered or contracted before or during (but did not arise out of) the person's relevant service" (s10(2)). Practically, this means that clinical-worsening factors cannot be used to argue that IHD first arose out of service; they are limited to aggravation of pre-existing disease in the defined circumstances.

4. Quantitative thresholds that are sometimes counterintuitive

• BMI threshold: "Being obese or overweight" is defined as BMI of 25 or greater, or waist circumference thresholds (Schedule). That groups overweight and obese under a single label for the SOP; practitioners must avoid assuming an obesity-specific threshold if only BMI≥30 is commonly considered obese in clinical contexts.
• Lipid values: The SOP requires specific lipid thresholds (HDL <1.0 mmol/L; LDL >4.0 mmol/L; total cholesterol >5.5 mmol/L) or regular administration of lipid-lowering therapy (s9(4)). Lack of recorded lab values that meet these thresholds may defeat reliance on dyslipidaemia even where a clinician has noted "hypercholesterolaemia".

5. Pack-year conversion and tobacco equivalence

• The Schedule defines one pack-year as 20 cigarettes per day for one year and provides an equivalence of 7,300 grams of smoking tobacco and an unconventional conversion where 1 gram of pipe tobacco or cigars is considered equal to one cigarette (Schedule). Misapplication of or failure to compute pack-years correctly can cause mis-evaluation of smoking-related factors (s9(5)-(7)). Note also the distinct cessation windows and pack-year cut-offs that alter qualification (s9(5)-(7)).

6. Evidence difficulty for exposures and behaviours

• Several factors require accumulation or averages over several years: being sedentary "for a cumulative total of at least 10 hours per day on more days than not for at least the 5 years" (s9(11)); inability to consume an average of at least 100 grams/day of vegetables or fruit for at least 5 years (s9(12)); chronic kidney disease criteria require GFR or albuminuria for at least 3 months (s9(13)). These are often not captured in routine medical records and can be hard to reconstruct credibly.
• Hours-based exposures: Proving 1,000 hours in enclosed spaces exposed to second-hand smoke, or 1,000 hours of Otto fuel II or herbicide exposure within specified periods, will commonly require employment logs, service manifests or credible witness statements. The instrument’s specific hours thresholds create evidentiary pressure.
• Polluted air thresholds: The Schedule defines "chronically polluted air" (annual average PM2.5 >20 µg/m3) and "polluted air" (24-hour average PM2.5 >50 or PM10 >100) , verifying these requires environmental monitoring data which may not be readily available for historical service locations.

7. Lag periods and cessation windows

• Some exposures require both cumulative exposure and a minimum latency. For example, Otto fuel II exposure requires cumulative 1,000 hours within a consecutive 10 years and "where the first exposure occurred at least 5 years before clinical onset or clinical worsening" (s9(22)). If the first exposure is more recent than 5 years, the factor will not be met even if cumulative hours are reached.
• Similarly, for prior smoking that ceased, the relevant pack-year thresholds interact with time since cessation (s9(6)) and therefore a long-ago smoking history may not meet the SOP unless the pack-year threshold or cessation time lines up.

8. Proximate triggers versus chronic risks

• The SOP mixes long-term, chronic risk factors (hypertension, diabetes, obesity) with proximate triggers that operate within 24-48 hours of onset (acute stressors, illicit drugs, envenomation, acute hypersensitivity). Practitioners must be careful to tie the correct type of evidence to the correct factor type.

9. Complex medical categories and overlapping diseases

• Many autoimmune, vasculitic and inflammatory diseases are listed (s9(18)-(20)). Where a factor refers to a disease that itself has an SOP, clause s11 requires application of that other SOP instead, but practitioners must identify whether the listed disease has its own SOP and which terms apply.

10. "Inability to obtain appropriate clinical management"

• The SOP includes "inability to obtain appropriate clinical management for ischaemic heart disease before clinical worsening" (s9(58)). This is undefined in the instrument and will be interpreted case by case; contemporaneous records of attempts to access care, transfers, refusals, or documented resource limitations will be critical.

11. Death inclusion

• The definition of "death from ischaemic heart disease" includes death from a terminal event or condition contributed to by the person’s IHD (s7(3)). For coronial or cause-of-death evidence, practitioners must ensure the terminal event is linked to underlying IHD consistent with the SOP’s definition.

What compliance means in this administrative context

Compliance here means producing the evidence and expert opinion necessary to show that at least one of the listed factors existed and that that factor was related to the claimant’s relevant service (s9; s10(1)). Because the SOP sets out exact thresholds, compliance requires an evidentiary strategy that maps documentary and expert evidence against each relevant subsection.

Practical evidence checklist, organised by common factor types

1. Chronic medical risk factors (hypertension, diabetes, dyslipidaemia, obesity)

• Hypertension: medical records showing diagnosis and dates, blood pressure readings, GP or specialist notes, antihypertensive prescriptions and compliance records.
• Diabetes mellitus: pathology records (HbA1c, fasting glucose), medication histories, clinical notes with diagnosis and dates.
• Lipids: laboratory records with serum HDL, LDL and total cholesterol values; if on lipid-lowering therapy, prescription records and notes indicating prior elevated lipids (s9(4)).
• Obesity / BMI: contemporaneous weight and height measurements to calculate BMI (BMI = W/H2 is defined in Schedule); waist circumference records if available (Schedule definition of being obese or overweight).

2. Tobacco and smokeless tobacco

• Smoking history: detailed smoking history enabling pack-year calculation using the Schedule Note and formula; contemporaneous medical notes, workplace health assessments, or service medical records. Use the Schedule conversion rules where pipe or cigar tobacco are involved.
• Second-hand smoke: workplace or service postings, incident/roster records indicating enclosed-space environments, witness statements, and any environmental testing data to support hours-in-enclosed-spaces quantification.
• Smokeless tobacco: evidence of daily/near-daily use documented in medical or service files; noting cessation dates where relevant.

3. Occupational and environmental exposures (Otto fuel II, herbicides, TCDD, polluted air)

• Otto fuel II and herbicides: service records, unit logs, occupational exposure records, task lists, safety data sheets, maintenance logs that record handling or exposure, witness statements from comrades, and dates to show cumulative exposure hours and first-exposure date.
• TCDD-contaminated agents: records of activities listed in the Schedule (decanting, spraying, handling treated timber), maintenance logs, and any industrial hygiene reports.
• Polluted air: environmental monitoring data for the relevant location and period showing PM2.5/PM10 concentrations; if monitoring data are unavailable, triangulate with contemporaneous reports, operational records and expert environmental reconstruction.

4. Radiation and radiotherapy

• Radiotherapy: oncology treatment records specifying whether the heart was in the field of radiation, dose per fraction, total dose and dates.
• Cumulative equivalent dose to the heart: dosimetry records, radiotherapy planning documents and any occupational dose monitoring (Schedule defines cumulative equivalent dose and exclusions for background radiation).

5. Acute proximate triggers (stressors, infection, illicit drugs, temperature)

• Acute stressors: contemporaneous incident reports, operational logs, witness statements and, where relevant, mental health or counselling notes describing category 1A/1B stressor events or other defined stressful events within the SOP’s specified windows (Schedule defines category 1A/1B).
• Infection: pathology reports verifying SARS‑CoV‑2 diagnosis and dates, or records showing influenza/lower respiratory tract infection within 30 days.
• Illicit drugs or medication triggers: toxicology reports if taken within the required prior window (e.g. 24 hours), witness statements, medical records indicating drug use, or prescription records where appropriate.

6. Functional and behavioural criteria (physical activity, sedentary behaviour, diet, sleep)

• Physical activity and METs: specialist functional assessments, occupational fitness reports, cardiopulmonary exercise tests, or expert functional opinion to establish inability to undertake activities >3 METs for the relevant period.
• Sedentary behaviour: employment role descriptions, duty rosters, and evidence of habitual sedentary work over the 5-year period.
• Diet: contemporaneous dietary surveys, GP/nutritionist notes, or credible witness statements indicating average daily fruit/vegetable intake.
• Sleep: sleep studies for sleep apnoea, sleep clinic records, and documentary evidence for chronic average sleep hours under the SOP thresholds.

7. Procedures, infections and specific disease states

• Catheterisation within 30 days: procedural notes, operation reports and intervention dates.
• Infective endocarditis, syphilis involving coronary arteries, autoimmune or vasculitic diseases: specialist notes, laboratory confirmations (autoantibodies, cultures), imaging, and histopathology as applicable.
• Chronic kidney disease: GFR values, albumin:creatinine ratio results and duration documentation (s9(13)).

8. Medication-based factors

• For the listed medications and drug classes with short temporal windows (e.g. within 24 hours or 24-48 hours), produce prescription records, pharmacy dispensing notes and administration records indicating timing relative to clinical onset (s9(31)-(33)).

9. "Inability to obtain appropriate clinical management"

• Document attempts to access care: appointment logs, referral rejections, transfer or evacuation records, contemporaneous complaints or correspondence, and any service-issued limitations that prevented access. Where available, cite clinical notes noting delayed or absent treatment.

Expert opinion

• Experts should be instructed to link specific facts to the relevant SOP clause. For example, an expert opinion should state which clause(s) of s9 the expert relies upon, explain how the documentary evidence meets the clause’s thresholds (e.g. exact lipid values, pack-year calculations, hours of exposure), and address nexus to relevant service.
• For exposures or behaviours that are not easily documented (diet, sedentary hours, second-hand smoke hours), experts should provide reasoned reconstruction grounded in contemporaneous records, plausible assumptions and accepted methodology, and identify any evidential gaps.

Drafting claims and submissions

• Map the claim file directly to the SOP: create a table or schedule that cites each alleged factor to the SOP subsection, lists the supporting documents with dates, and provides the expert’s page/paragraph references that explain how the threshold is met.
• For clinical worsening cases, include a clear timeline showing that IHD was suffered or contracted before or during relevant service and did not arise out of service, as required in s10(2). If the claimant alleges material contribution or aggravation, the expert’s opinion must address materiality relative to pre-existing disease.

Record-keeping and conversions

• Use the Schedule’s definitions and conversion rules. Compute pack-years using the Schedule Note 2 formula and convert any non-cigarette tobacco using the Schedule equivalences. Calculate BMI as defined (BMI = W/H2).
• Where environmental thresholds are required, obtain authoritative monitoring data or official environmental reports for the relevant locations and periods.

Administrative practice considerations

• Anticipate questions about historic exposures where precise monitoring is unavailable: prepare supporting contemporaneous documentation (logs, unit diaries, maintenance records, witness statements) and instruct experts on acceptable reconstruction approaches.
• For claims involving death, obtain coronial findings, death certificates, terminal event information and clinical summaries that link the terminal event to underlying IHD as defined in the Schedule (terminal event examples include pneumonia, cardiac arrest, circulatory failure) (s7(3), Schedule).

Final note on strategy

• The SOP lowers the theoretical medical causation question to a specific checklist; effective compliance is documentary and expert-led. The stronger the contemporaneous documentation and the clearer the expert linkage to the precise SOP clause and to relevant service, the more likely the administrative decision-maker can find that a reasonable hypothesis has been raised (s9; s10).