Statement of Principles concerning melioidosis (Balance of Probabilities) (No. 56 of 2023)

The central concept is “melioidosis”, defined in subsection 7(2) as illness caused by infection with the bacterium Burkholderia pseudomallei. The definition is not limited to any particular ICD‑10‑AM coding; the four codes (A24.1, A24.2, A24.3, A24.4) are listed only as a cross‑reference, and the meaning in subsection (2) governs. The note to subsection 7(2) explains that melioidosis may present as acute, chronic, or latent infection, with clinical manifestations ranging from local infection to septicaemia, meningoencephalitis and chronic suppurative infection. This broad definition means a claimant need not have a particular diagnostic code; any infection with B. pseudomallei that causes illness qualifies, provided the other criteria are met.

The second key concept is “relevant service”, defined in the Dictionary to mean eligible war service (other than operational service) under the VEA, defence service (other than hazardous service and British nuclear test defence service) under the VEA, or peacetime service under the MRCA. This SoP applies only to those categories of service where the balance‑of‑probabilities standard is used for claims. Operational service under the VEA and hazardous service under the MRCA use the reasonable‑hypothesis standard, and a separate SoP (the Reasonable Hypothesis SoP for melioidosis) would apply to those. The distinction is critical: this SoP is for claims where the burden is on the claimant to prove, on the balance of probabilities, that the disease is related to service. The SoP itself does not change the standard of proof; it operationalises it by providing a checklist of factors that, if satisfied, create a deemed connection.

The third concept is the “factor” itself. Section 9 sets out seven factors: exposure to B. pseudomallei before clinical onset; being in an immunocompromised state as specified at the time of clinical onset; having a medical condition from the specified list at the time of clinical onset; alcohol consumption thresholds (65 kg for males, 44 kg for females within 3 years before onset); having alcohol use disorder at the time of onset; or inability to obtain appropriate clinical management for melioidosis. Each factor is defined in the Dictionary. The exposure factor covers ingestion, direct contact (without a protective barrier), inhalation, and medical procedures involving contaminated objects. The immunocompromised state is defined by a list: haematological or solid organ malignancy, chronic renal failure, severe malnutrition, taking an immunosuppressive drug, or having had a solid organ, stem cell, or bone marrow transplant. Immunosuppressive drug is further defined as a drug that results in substantial suppression of immune responses, with non‑exhaustive examples including chemotherapeutic agents, systemic corticosteroids, transplant rejection drugs, and tumour necrosis factor‑α inhibitors. The specified list of medical conditions includes chronic kidney disease, chronic lung disease (bronchiectasis and COPD), cirrhosis of the liver, diabetes mellitus, heart failure, and rheumatic heart disease. Chronic kidney disease itself is defined by four alternative criteria: GFR <60 for at least 3 months, albuminuria for at least 3 months, kidney damage on biopsy or imaging, or a prior kidney transplant. Chronic renal failure (a separate defined term used in the immunocompromised definition) requires GFR <15 for 3 months, or need for dialysis or transplant. These definitions are layered and designed to be objective, verifiable by medical records.

The Dictionary also defines “terminal event” as pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function. This is used to extend the SoP to death where melioidosis contributed to one of these terminal events.

Section 10 requires that any factor must be related to the relevant service rendered by the person. This is the service‑connection gateway. In addition, the factor in subsection 9(7) (inability to obtain appropriate clinical management) applies only where the melioidosis was suffered or contracted before or during (but did not arise out of) the person’s relevant service. This limits the scope of that factor to aggravation or material contribution, not initial causation.

Section 11 incorporates by reference any other Statement of Principles that deals with an injury or disease referred to in a factor. For example, if a factor refers to “alcohol use disorder” or “chronic renal failure”, the SoP for that condition (if one exists under subsection 196B(3)) will apply in determining whether that condition exists. This prevents re‑litigation of the causal factors for the underlying condition and ensures consistency across SoPs.

The primary affected persons are veterans and members of the Australian Defence Force who have rendered relevant service (as defined: eligible war service other than operational service, defence service other than hazardous service, or peacetime service under the MRCA) and who claim that melioidosis is related to that service. This includes veterans who served in parts of Australia or overseas where B. pseudomallei is endemic, particularly northern Australia, Southeast Asia, and the Pacific. The SoP also affects their dependants and family members in the event of death from melioidosis, as death claims may be assessed under section 10.

Decision‑makers are directly bound: the Repatriation Commission, the Military Rehabilitation and Compensation Commission, the Veterans’ Review Board, and the Administrative Appeals Tribunal. They must apply the factors in section 9 when determining whether the threshold for service connection is met on the balance of probabilities. The SoP constrains their discretion: if a factor is present and related to service, they must find the connection unless the evidence raises a reasonable hypothesis (which would shift the standard). For claimants, the SoP defines what medical evidence they need to gather: proof of exposure to B. pseudomallei, evidence of an immunocompromised state, a specified medical condition, alcohol consumption records, or evidence of denied clinical management. The SoP also affects healthcare providers who may be asked to provide opinions on whether a condition qualifies (e.g., whether a person had chronic kidney disease under the strict definition).

The instrument does not affect the general public; it is limited to the veterans’ entitlements and military compensation systems. However, it has indirect effects on the Department of Veterans’ Affairs and the Department of Defence, which must process claims and potentially pay compensation (including incapacity payments, medical treatment, and dependant pensions) if the connection is established. The SoP therefore has budgetary implications, as it sets the bar for compensation. The alcohol consumption thresholds, for instance, may allow more claims from veterans with heavy drinking histories, which could increase the number of accepted claims compared with the previous 2014 SoP, depending on what the earlier factors were (the 2014 SoP is not before us, but its repeal indicates a change in the evidence base). The instrument also affects medical researchers and epidemiologists who track B. pseudomallei exposure in military cohorts, as the defined exposure routes provide a standard for attribution.

Finally, the SoP affects legal practitioners and advocates who represent veterans. They must understand the definitions and the hierarchy of factors to advise clients on the likelihood of success and to gather the necessary evidence. The interplay with other SoPs under section 11 adds complexity, as it requires checking whether a factor condition has its own SoP and, if so, applying those factors to establish the condition.

The instrument does not impose duties directly on claimants or service providers; rather, it establishes evidentiary duties on decision‑makers and creates a right for claimants to have their claim assessed according to the prescribed factors. The key duty is on the Repatriation Commission and the MRCC to accept that melioidosis is connected with relevant service if at least one factor in section 9 exists and that factor is related to the person’s service (section 10). This is presumptive: if the evidence shows the factor exists, the decision‑maker must find the connection, unless the contrary is proved (the balance of probabilities standard is already the claimant’s burden, but this SoP lightens that burden by setting out specific pathways). In practice, the decision‑maker has a duty to consider each factor, request relevant medical evidence, and make a reasoned decision.

Claimants have the right to have their claim assessed in accordance with the SoP. They can provide evidence of any of the seven factors. The right is not to automatic acceptance, but to a proper application of the SoP. If a decision‑maker fails to apply the SoP correctly, the claimant can seek review by the Veterans’ Review Board and then the AAT. The SoP also gives claimants a right to rely on the “inability to obtain appropriate clinical management” factor (subsection 9(7)) if they can show that the Department or a service medical provider denied or failed to provide timely clinical management for melioidosis, and that this contributed to the onset or aggravation of the disease. This is the only factor that explicitly engages a duty on the Department or service authority: a failure to provide appropriate clinical management may itself become the basis for a claim.

The instrument also creates a duty on medical practitioners and the Department to maintain records relevant to the factors. For example, the alcohol consumption factors rely on the Australian Standard drink of 10g of alcohol; the decision‑maker must calculate total consumption over three years. This imposes a practical duty on claimants to document their alcohol intake, and on the Department to accept self‑reports, medical records, or other evidence.

The Dictionary imposes a duty on those interpreting the SoP to use the precise definitions. For example, “direct contact” requires physical contact without any protective or impermeable barrier. This means that wearing gloves, a mask, or a protective suit during exposure would negate that exposure route under paragraph (b) of the “being exposed” definition. Claimants cannot rely on exposure if they used standard personal protective equipment. Similarly, the immunocompromised state definition requires “substantially lowered immune function”; the listed examples are deemed to satisfy this, but other causes of immune suppression (e.g., HIV/AIDS, primary immunodeficiency) are not listed and thus do not automatically qualify. The claimant would have to argue that their condition falls within the definition, which is a higher hurdle.

Rights also arise under section 11: if a factor refers to an injury or disease that has its own SoP, that SoP applies as in force from time to time. This gives a claimant the right to rely on updated versions of those SoPs (e.g., an updated alcohol use disorder SoP) without the melioidosis SoP needing amendment. Conversely, it means the decision‑maker must check the current version of those other SoPs, potentially creating a moving target.

This instrument does not create criminal penalties or civil penalties for non‑compliance. It is a legislative instrument that sets evidentiary standards for entitlement decisions, not a prohibition‑based regulatory scheme. The only “penalty” for a claimant who fails to satisfy any factor is that their claim for melioidosis being service‑related will be rejected. There is no fine, imprisonment, or administrative sanction for the claimant. For decision‑makers, failure to correctly apply the SoP can lead to a decision being set aside on review. This is not a penalty in the traditional sense but a legal consequence. The Veterans’ Entitlements Act 1986 contains provisions for false statements and fraud (e.g., section 205), but those are not specific to this SoP. The SoP itself has no enforcement mechanism.

However, the SoP can be enforced indirectly through administrative law. A veteran or member who is dissatisfied with a decision that fails to consider or misapplies a factor can seek merits review at the Veterans’ Review Board and then the AAT. The AAT can substitute its own decision and must apply the SoP. Judicial review in the Federal Court is available for jurisdictional error, but that is a separate process. The SoP also binds the Commission and the Board as a matter of law; a decision that ignores a factor that clearly exists could be overturned.

For the Repatriation Medical Authority, the SoP itself is a determination that must be made in accordance with the VEA and the statutory duty to consider sound medical‑scientific evidence. If the Authority failed to follow its own procedures or made a determination without evidence, it could potentially be challenged by way of judicial review, though such challenges are rare. The instrument is a legislative instrument subject to disallowance by either House of Parliament under the Legislation Act 2003, which is a form of external oversight, but not a penalty.

The Dictionary definitions are drafted to avoid ambiguity and reduce the risk of inconsistent enforcement. The use of objective clinical thresholds (e.g., GFR less than 60, albumin to creatinine ratio at least 3 mg/mmol) is designed to minimise discretion and make enforcement by review bodies more uniform. A decision‑maker who incorrectly assesses a GFR reading could be reversed on review. The practical enforcement mechanism is the claimant’s right to challenge the decision, not any state‑imposed penalty.

This instrument is made under subsection 196B(3) of the VEA and is part of a broader framework of Statements of Principles that cover hundreds of diseases. It interacts directly with the VEA and the MRCA, particularly sections 120B and 339, which require the decision‑maker to be satisfied, on the balance of probabilities, that the disease is connected to service. The SoPs are the primary mechanism through which that satisfaction is determined; the decision‑maker cannot rely solely on general medical evidence if a relevant SoP exists. Section 196B of the VEA requires that the Authority determine a SoP where it finds that the medical‑scientific evidence indicates a causal connection. This SoP covers the balance‑of‑probabilities standard; a separate SoP for melioidosis under the reasonable‑hypothesis standard (subsection 196B(2)) would apply to operational service claims. The interaction means that a veteran with operational service (e.g., active war service) would not use this SoP; they would use the reasonable‑hypothesis version, which has a lower evidentiary threshold and different factors. This SoP only applies to eligible war service (non‑operational), defence service (non‑hazardous), and peacetime service.

The instrument also interacts with other Statements of Principles through section 11. If a factor refers to a condition that has its own SoP (e.g., chronic renal failure, alcohol use disorder), that SoP governs the existence of that condition. This creates a chain of references: to prove the factor of having alcohol use disorder at the time of onset, the claimant must satisfy the factors in the alcohol use disorder SoP (if one exists). This can complicate claims, as the underlying condition must be established under its own rules. It also means that amendments to other SoPs automatically affect melioidosis claims without amending this SoP.

The Dictionary definitions intersect with clinical practice guidelines and standard diagnostic criteria. For example, the definition of chronic kidney disease uses the commonly accepted GFR threshold of less than 60 and the albuminuria criterion, aligning with the Kidney Health Australia guidelines. The definition of chronic renal failure uses the GFR less than 15 threshold, consistent with the Classification of Chronic Kidney Disease. This reduces conflict with medical evidence. However, the definition of “immunocompromised state as specified” does not align perfectly with all medical definitions; it lists specific conditions and omits others (e.g., HIV with low CD4 count, primary immunodeficiency syndromes). This could create a gap where a person is medically immunocompromised but not under the SoP. The claimant would then need to rely on another factor, such as a specified medical condition, or argue that the condition is analogous, but the definition is exhaustive (“such as would occur in the following conditions or circumstances”) and the listed items appear exhaustive, so it may not be open.

The instrument also interacts with the Administrative Appeals Tribunal Act 1975 and the Veterans’ Entitlements (Review) Act 1986 through the review process. The AAT is bound to apply the SoP as a legislative instrument. The Instrument interacts with the Evidence Act 1995 only indirectly; the SoP’s definitions are matters of law, not evidence.

The “inability to obtain appropriate clinical management” factor (subsection 9(7)) interacts with the concept of “material contribution” and aggravation, found in sections of the VEA and MRCA dealing with injuries and diseases that arise out of or are aggravated by service. It recognises that a failure to provide timely or appropriate medical care can be a service‑related cause. This factor is unique in that it imposes a form of fault on the Department or Defence, potentially leading to broader liability than a simple exposure factor.

This instrument is a standalone legislative instrument that replaces the earlier Statement of Principles concerning melioidosis No. 61 of 2014 (F2014L00934) made under the same subsection 196B(3) of the VEA. The 2014 SoP is repealed in full by section 4 of this instrument. The new SoP commences on 23 May 2023. The Federal Register of Legislation reference for the 2014 SoP is provided, but the text of that instrument is not before us. The amendment history beyond this replacement is limited to this single repeal‑and‑replace event. The instrument does not include any transitional provisions; presumably, claims lodged before 23 May 2023 would be assessed under the former SoP unless the new instrument expressly applies to pending claims. Section 5 states it applies to a claim to which section 120B of the VEA or section 339 of the MRCA applies. Those provisions determine the standard of proof; the SoP is applied as at the date of decision, but the transitional provisions of the VEA (not reproduced here) would govern whether the new SoP applies to claims lodged before commencement. Typically, a new SoP is applied to all claims not finally determined before commencement, unless the instrument specifies otherwise. No such specification appears here.

The Authority has updated the SoP based on sound medical‑scientific evidence available at the time of making. The repealed 2014 SoP presumably contained different factors or definitions. For instance, the alcohol consumption thresholds (65kg male / 44kg female) may be new or revised. The inclusion of “inability to obtain appropriate clinical management” as a factor may be new; it was not necessarily in the 2014 version. The definitions of chronic kidney disease and chronic renal failure are detailed and likely reflect updated medical classification. The Dictionary also includes albuminuria as a separate defined term, which may have been absent from the 2014 SoP. The note to the alcohol consumption factors states that alcohol is measured by the Australian Standard of 10g per standard drink; that standard has not changed, but the total volumes may be new.

There is no mention of any amendment between 2014 and 2023, so the 2014 SoP remained in force for nine years. This suggests that the Authority periodically reviews and updates SoPs when new medical evidence emerges. The instrument does not have a sunset or review clause. As a legislative instrument, it can be amended or repealed by a later instrument. It would not automatically expire unless the Authority decides to revoke it or a new version is made.

The instrument itself does not mention any litigation history. The SoP is a legislative instrument, and its interpretation has likely been considered in decisions of the Administrative Appeals Tribunal and the Federal Court, but no cases are cited. Given that this SoP replaces a 2014 version, there may be tribunal decisions that interpreted the 2014 version, but those are not authoritative for the new version. Claimants and decision‑makers should be aware that any body of case law on the definition of “melioidosis” or “exposure” under the previous SoP may no longer be directly applicable if the definitions have changed. For example, if the 2014 SoP defined “exposure” differently, AAT decisions on that point are not binding under the new SoP.

The absence of cited litigation is notable. The Repatriation Medical Authority is not required to list judicial decisions; it simply makes the SoP based on medical evidence. However, it is known that SoPs have been challenged in the Federal Court on grounds such as jurisdictional error or failure to consider relevant evidence. The High Court has considered the SoP system in cases such as Repatriation Commission v Dean (1997) and Repatriation Commission v Geyer (2002), but those are not mentioned. The instrument’s litigation risk arises from the definitions. For example, a veteran might argue that the “immunocompromised state as specified” definition is too narrow and does not account for modern treatments or conditions like HIV. A court could find that the Authority failed to consider certain evidence, or that the definition is inconsistent with the VEA. However, the instrument has not yet been litigated (or if it has, it is not referenced). Practitioners should monitor AAT decisions on this specific SoP after its commencement date.

The lack of litigation history also means there is no settled interpretation of phrases like “inability to obtain appropriate clinical management” or “direct contact” beyond the text. The AAT may need to develop a jurisprudence on what constitutes an “inability” - whether it means a systemic failure, a one‑off refusal, or a lack of available treatment in the location. Likewise, “protective or impermeable barrier” in the direct contact definition may be ambiguous for partial barriers or ineffective barriers.

Several traps lie within the instrument’s definitions. First, the “being exposed to Burkholderia pseudomallei” definition requires that the exposure occurred before the clinical onset of melioidosis. The instrument does not define how soon before onset; theoretically, exposure could be decades earlier given latent infection. However, the note in subsection 7(2) states melioidosis may present as a latent infection, so a gap of years may be acceptable. But the claimant must still prove exposure, which may be difficult if the service was in an endemic area but no specific incident is recorded. The “fluid contaminated” and “water or soil contaminated” routes do not require the claimant to identify the source; but they must show contamination existed. This could be proven by epidemiological evidence of endemicity. However, the definition requires “direct contact” without a protective barrier for skin/mucous membrane contact (sub‑paragraph (b)). A veteran who handled contaminated soil while wearing gloves would not meet that sub‑paragraph. They could still rely on contamination‑through‑ingestion or inhalation, but that may be harder to prove.

Second, the immunocompromised state definition is exhaustive. It lists five specific conditions or circumstances. Importantly, HIV infection is not listed. The catch‑all phrase “a condition of substantially lowered immune function” is immediately qualified by “such as would occur in the following conditions or circumstances”. The word “such as” suggests the list is illustrative, but the phrasing “as specified” and the structure of the definition indicate that the list is the specification. A veteran with HIV/AIDS and a very low CD4 count would not automatically qualify. They would need to argue that their condition falls within the definition, but the decision‑maker is likely to read the list as exhaustive because the heading is “immunocompromised state as specified” and the list is the specification. Similarly, immunosuppressive drugs are defined with examples; an unlisted drug would need to be shown to “result in substantial suppression of immune responses”. A brief course of oral steroids may not qualify; only non‑inhaled or non‑topical corticosteroids are included. Inhaled corticosteroids for asthma are excluded, even though high doses can have systemic effects. Claimants must ensure the drug fits the definition.

Third, the alcohol consumption thresholds are total grams over three years, not daily averages. 65 kg of alcohol for males equates to 6,500 standard drinks over three years, or about 5.9 standard drinks per day on average. This is a high threshold, likely targeting chronic heavy drinkers. A veteran who drinks heavily but not every day may fall short if their total is lower. The measurement is “within the 3 years before the clinical onset”, so the date of onset is critical. If the onset is uncertain, the timing may be disputed. Moreover, the factor only applies if the alcohol consumption is a cause (via immunocompromise or direct effect), but the SoP does not require proof of mechanism; it is a sufficient factor on its own. So a veteran who drinks heavily and then develops melioidosis without any other risk factor may succeed.

Fourth, the “specified list of medical conditions” includes “chronic lung disease including bronchiectasis and chronic obstructive pulmonary disease”. It does not include asthma, interstitial lung disease, or cystic fibrosis (though bronchiectasis is common in cystic fibrosis, cystic fibrosis itself is not listed). A veteran with asthma alone would not qualify under this factor. The list also includes heart failure and rheumatic heart disease, but not ischaemic heart disease without heart failure. Claimants with other conditions not listed cannot rely on this factor.

Fifth, the “inability to obtain appropriate clinical management” factor (subsection 9(7)) is limited by subsection 10(2): it applies only to material contribution to, or aggravation of, melioidosis where the melioidosis was suffered or contracted before or during (but did not arise out of) relevant service. This means the factor cannot be used for initial causation; it only helps in cases where the disease existed before service and service‑related failures worsened it or contributed to a terminal outcome. It also requires that the inability be a factor in the aggravation or material contribution. The definition of “appropriate clinical management” is not defined; it will be a matter of medical opinion. This could lead to disputes about what constitutes appropriate management for melioidosis.

Sixth, the instrument uses the term “relevant service” as defined, which excludes operational service and hazardous service. A veteran who served in a war zone (operational service) and acquires melioidosis cannot use this SoP; they must rely on the reasonable‑hypothesis version. Many veterans may be confused and attempt to use this one incorrectly.

Seventh, the “inability to obtain appropriate clinical management” factor has no time limit; it could apply years after service if the Department’s failure to provide care continues. However, the onset must already have occurred; the factor then contributes to aggravation. This could be a tricky issue for post‑service care.

For veterans and members claiming melioidosis is service‑related under the balance of probabilities, compliance means gathering evidence to establish at least one of the seven factors and proving that factor is related to their relevant service. The first step is to obtain a definitive diagnosis of melioidosis, confirmed by culture, PCR, or serology of B. pseudomallei infection, and to establish the date of clinical onset. This is essential because many factors require the presence at the time of onset. The claimant should collect medical records showing the diagnosis and the date.

For the exposure factor, the claimant needs to show they consumed contaminated water or food, had direct skin or mucous membrane contact with contaminated fluid, blood, tissue, water, or soil, inhaled contaminated dust or aerosol, or underwent a contaminated medical procedure. Evidence could include deployment records to endemic areas (e.g., Northern Territory, Queensland, Papua New Guinea, Thailand, Vietnam), reports of known contamination events in military bases, or personal testimony of exposure (e.g., working without gloves in muddy water). The exposure must have occurred before onset. If the claimant was in an endemic area for a long period, a general statement of exposure may be insufficient; the decision‑maker may require evidence of a specific incident or a high risk of contamination. The note to the definition does not require proof of actual contamination for the water/soil route, but it must be “contaminated”. For the inhalation route, dust or aerosol must be contaminated. If the area is known to have B. pseudomallei in soil, that may suffice.

For the immunocompromised state factor, the claimant must provide medical evidence of one of the listed conditions: haematological or solid organ malignancy, chronic renal failure (GFR <15 or dialysis), severe malnutrition, or being on an immunosuppressive drug, or having had a transplant. The evidence should include pathology results, biopsy reports, drug prescriptions, and transplant records. The drug must be one that substantially suppresses immune responses; the examples give guidance. Claimants on a short course of prednisolone for an allergic reaction may not meet the “substantial” threshold.

For the specified list of medical conditions factor, the claimant needs evidence of chronic kidney disease (GFR <60 for 3 months, albuminuria, kidney damage, or transplant), chronic lung disease (bronchiectasis or COPD), cirrhosis, diabetes mellitus, heart failure, or rheumatic heart disease. Each condition has its own diagnostic criteria; the definitions in the Dictionary for chronic kidney disease and chronic renal failure are detailed and must be met. For diabetes, standard diagnosis by fasting glucose or HbA1c should be acceptable; heart failure will need echocardiogram evidence.

For the alcohol consumption factors, the claimant needs to document their total alcohol intake over the three years before onset. This is often self‑reported but can be corroborated by medical records (alcoholism diagnoses, liver function tests, AUDIT scores). The calculations must use the Australian standard of 10g per drink. Claimants should provide a detailed drinking history. The 65 kg (male) / 44 kg (female) threshold is high; claimants who drank heavily for a shorter period may not meet it unless they also qualify under the alcohol use disorder factor. The alcohol use disorder factor (subsection 9(6)) requires a DSM‑5 diagnosis of alcohol use disorder at the time of onset. That diagnosis can be made from medical records.

For the inability to obtain appropriate clinical management factor, the claimant must show that the Department or Defence failed to provide timely or appropriate treatment for melioidosis, and that this failure contributed to the onset or aggravation of the disease. This requires evidence of the clinical management offered (or not offered) and an expert opinion that the management was inappropriate or insufficient. Claimants should preserve all medical records and correspondence with the Department about treatment.

Decision‑makers must comply by systematically checking each factor against the evidence. They should not rely on a medical opinion that the disease is service‑related without first determining whether a factor exists. The SoP is binding; if a factor is present and related to service, the decision‑maker must find the connection. They must also apply section 11 to incorporate other SoPs if a factor condition has one. They should keep the current versions of all SoPs on hand. They must also interpret the definitions strictly; for example, “direct contact” without a barrier means if the veteran wore a mask or gloves, that route is inapplicable. The decision‑maker should ask the claimant for details of protective equipment used.

Legal practitioners should advise claimants to focus on the factor with the strongest evidence. If the veteran served in an endemic area and developed melioidosis within a few years, the exposure factor may be easiest. If the veteran has diabetes or heavy alcohol use, those factors should be pursued. The alcohol factors do not require proof of causation beyond the alcohol itself; they are self‑standing. The immunocompromised factor may be harder if the condition is not strictly within the list. Practitioners should also check the reasonable‑hypothesis SoP for melioidosis if the veteran’s service is operational, as the factors may differ.

Finally, the claimant should be aware that the SoP applies only to the balance‑of‑probabilities standard. If they have operational service, they need the reasonable‑hypothesis SoP, which has a lower threshold. They should not file under the wrong standard. The Department may internally determine whether the service is operational or not; claimants should check their service type.