Statement of Principles concerning mesenteric panniculitis (Reasonable Hypothesis) (No. 49 of 2018)

The central concepts in the instrument are definitional clarity for mesenteric panniculitis, the threshold factors that raise a reasonable hypothesis of nexus with relevant service, and the temporal/causal limits on when particular factors apply.

Definition of mesenteric panniculitis: The instrument defines the disease as an inflammatory condition of the fatty layer beneath the mesentery, omentum and peritoneum that is clinically symptomatic or requires treatment (s 6(2)(a)). It explicitly excludes several separate conditions and radiological phenomena: sclerosing encapsulating peritonitis, retroperitoneal fibrosis (Ormond disease), peritoneal adhesions, acute peritonitis, infectious peritonitis, and the radiological phenomenon termed "misty mesentery" not diagnosed specifically as mesenteric panniculitis (s 6(2)(b)). The instrument also confirms that, although the condition attracts ICD‑10‑AM code K65.8, the statutory meaning for claims purposes is the textual definition in s 6(2) rather than reliance on the code alone (s 6(3)-(4)). The instrument clarifies that mesenteric panniculitis may be known by alternate names such as mesenteric lipodystrophy or sclerosing mesenteritis (Note 3 to s 6(2)).

Diagnosis and death: The instrument states diagnosis is by histology or abdominal imaging using established radiological criteria (Note 2 to s 6(2)). It treats death from mesenteric panniculitis as a death from a terminal event or condition that was contributed to by the disease; terminal events include pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function (s 6(5) and Schedule 1).

Threshold factors (factual triggers): Section 8 lists the factors that, if established, must as a minimum exist before a reasonable hypothesis can be raised. These are discrete and particular: abdominal infection with tuberculosis or atypical mycobacteria at clinical onset (s 8(1)) or at clinical worsening (s 8(2)); for disease of the colon only, colonoscopy within 48 hours before clinical worsening (s 8(3)); and inability to obtain appropriate clinical management for mesenteric panniculitis (s 8(4)). The instrument thereby constrains the medical-factual pathways by which a claimant may raise nexus: the listed factors are the minimal evidentiary predicates for the reasonable hypothesis.

Relationship to service and temporal limits: The instrument requires that the existence of any factor in s 8 must be related to the person's relevant service (s 9(1)). Further, subsections 8(2) to 8(4) are expressly limited to material contribution to or aggravation of the disease in cases where the person’s mesenteric panniculitis was suffered or contracted before or during, but did not arise out of, the person’s relevant service (s 9(2)). The Schedule defines "relevant service" in terms of specified categories under the VEA and MRCA (operational, peacekeeping, hazardous, British nuclear test defence, warlike, and non-warlike) (Schedule 1).

Interplay with other Statements of Principles: If a factor in s 8 refers to an injury or disease covered by another Statement of Principles determined under s 196B(2) of the VEA, then that other Statement's factors apply in accordance with its terms as in force from time to time (s 10). This establishes a mechanism for cross-referencing and prioritising other SOPs where co-morbid or causal conditions are already the subject of separate RMA instruments.

Basis for determination: The instrument records the RMA’s view that "there is sound medical‑scientific evidence" indicating the disease and death can be related to relevant service (s 7). That statement is presented as the Authority’s basis for prescribing the factors in s 8. The instrument does not specify the evidence itself or set out evidentiary standards beyond the factors and diagnostic notes.

Primary affected persons: The instrument applies to claimants who bring claims under the VEA s 120A or MRCA s 338 framework; those are the claims processes that ask whether a reasonable hypothesis exists linking an injury, disease or death to relevant service (s 4). The Schedule defines "relevant service" and therefore delimits who may rely on the instrument: operational service, peacekeeping service, hazardous service, British nuclear test defence service under the VEA, and warlike or non‑warlike service under the MRCA (Schedule 1). In practice, this means veterans, members of Peacekeeping Forces, and members of Forces covered by the VEA or MRCA who allege mesenteric panniculitis or death from it and who seek benefits via the statutory reasonable hypothesis pathways are the instrument’s direct audience (s 7).

Decision-makers and medical advisers: The Repatriation Medical Authority is the instrument’s author and the body that determined the Statement of Principles (cover sheet and s 3). The instrument constrains the medical-factual issues that decision-makers in the VEA and MRCA claims systems must consider when applying the reasonable hypothesis test, because it prescribes the factors that must exist as a minimum before a reasonable hypothesis can be said to be raised (s 8). The instrument does not itself decide entitlement. Administrative decision-makers responsible for benefit grants (not named in this instrument) will rely on these factors and the stated definitions when assessing claims under the relevant statutory sections (s 4).

Clinicians and treating providers: The instrument affects clinicians whose records will supply the diagnostic, microbiological, imaging, endoscopic and treatment records that underpin claims. The instrument’s diagnostic note (Note 2 to s 6(2)) requires histology or abdominal imaging using established radiological criteria for diagnosis. It also excludes nonspecific radiological findings such as "misty mesentery" where mesenteric panniculitis has not been specifically diagnosed (s 6(2)(b)). Clinicians’ reports will be the key source material to establish the factors in s 8.

Administrative and evidentiary burden-bearers: Claimants will have the burden of adducing evidence that the factors in s 8 exist and are related to relevant service under s 9(1). The instrument’s specificity as to which factors qualify means claimants must source and present specific kinds of evidence: microbiology or clinical records showing abdominal tuberculosis or atypical mycobacteria at onset or worsening (s 8(1)-(2)); colonoscopy timing records where disease involves the colon (s 8(3)); documentary evidence of inability to obtain appropriate clinical management (s 8(4)); and diagnostic histology or imaging (Note 2 to s 6(2)). Where a listed factor refers to another injury or disease that is the subject of a different Statement of Principles, claimants must comply with that other Statement’s requirements (s 10).

Other instruments and stakeholders: The instrument interacts with other Statements of Principles determined under s 196B(2) of the VEA (s 10). It also references ICD‑10‑AM coding context (s 6(3)-(4)), which links the instrument to clinical classification systems used by hospitals and clinicians, and therefore to coding and record-keeping processes within health systems.

This instrument does not create direct statutory obligations on third parties in the way that primary legislation does; rather it defines thresholds and meanings used in the VEA/MRCA claims processes. The practical duties and rights that follow from the instrument are therefore procedural and evidentiary for claimants and administrative decision-makers.

Claimant duties and evidentiary expectations

• Claimants seeking to rely on this Statement must establish that at least one of the factors in s 8 exists and that the existence of that factor is related to the person's relevant service (s 8, s 9(1)). This is the minimum factual threshold required to raise a reasonable hypothesis under the instrument.
• Where the claimant relies on subsections 8(2)-8(4) (i.e. abdominal infection at time of clinical worsening, colonoscopy within 48 hours before worsening for colon-only disease, or inability to obtain appropriate clinical management), the claimant must show the disease was suffered or contracted before or during, but did not arise out of, the person’s relevant service because those factors apply only in such temporal/causal circumstances (s 9(2)).
• Diagnosis requires histology or abdominal imaging using established radiological criteria (Note 2 to s 6(2)), so claimants must be able to produce or authoritatively reference such diagnostic materials if they seek to establish the underlying condition.

Decision-maker duties

• Decision-makers applying the reasonable hypothesis test under VEA s 120A or MRCA s 338 must treat the factors in s 8 as the minimal predicates for raising that hypothesis in relation to mesenteric panniculitis or death from it (s 4, s 8). The instrument constrains the evidentiary gate by specifying which medical-factual circumstances are sufficient, as a minimum, to raise a reasonable hypothesis.
• Where a factor refers to an injury or disease covered by another Statement of Principles, decision-makers must apply that other Statement in accordance with its terms as in force from time to time (s 10). That cross-reference creates a duty to consult and apply relevant existing SOPs.

Rights

• Persons with mesenteric panniculitis or whose death was contributed to by it may rely on this Statement when making claims under the VEA or MRCA reasonable hypothesis provisions (s 4). The Statement provides a clear list of acceptable nexus-raising factors which claimants can cite to frame their evidence.
• The instrument affirms that the RMA has considered and relied upon "sound medical‑scientific evidence" in setting the factors (s 7), which claimants can use to support the legitimacy of the prescribed factors when arguing a reasonable hypothesis has been raised.

Limits and exclusions

• The instrument excludes certain conditions and radiological findings from counting as mesenteric panniculitis for claims purposes (s 6(2)(b)). A claimant whose presentation is limited to one of the excluded diagnoses or to "misty mesentery" without a specific mesenteric panniculitis diagnosis cannot rely on this Statement for a reasonable hypothesis.
• The instrument limits the application of particular factors to circumstances where the disease was contracted or suffered before/during service but did not arise out of service (s 9(2)). This creates a substantive limitation on the rights claimants can assert based on those factors.

Procedural implication

• The Statement functions as an evidentiary and definitional guide; it does not itself award benefits nor set appeals processes. The rights to make claims under VEA s 120A or MRCA s 338 remain, and the Statement supplies the medical-factual benchmarks for those claims (s 4).

The instrument does not itself create criminal offences, civil penalties, or administrative sanctions. It is a Statement of Principles issued by the Repatriation Medical Authority under s 196B(2) of the VEA and operates as an interpretive and determinative tool in the statutory claims frameworks of the VEA and MRCA (s 3-4, s 7-10). Enforcement in the ordinary sense of penalty imposition is therefore not a feature of the instrument.

How enforcement functions in practice

• The instrument’s effect is procedural and evidential: it prescribes what medical-factual circumstances will, as a minimum, raise a reasonable hypothesis connecting mesenteric panniculitis or death from it to relevant service. Administrative decision-makers adjudicating claims under VEA s 120A or MRCA s 338 will apply these factors when deciding whether the reasonable hypothesis threshold is met (s 4, s 8). The outcome of that application determines entitlement to benefits under the parent legislation, and any denial or acceptance is enforced through the benefits system established by those Acts rather than by this instrument directly.
• Adverse administrative decisions (for example a claim refused because the factors in s 8 are not established) may be contested by the claimant through the statutory review and appeal mechanisms provided in the VEA or MRCA schemes. The instrument itself does not set those review pathways; it is an input to the decision-making that will be reviewed under the parent legislation.

Practical consequences of non-compliance or false evidence

• While the instrument does not create penalties, presenting false or misleading evidence to a claims authority may have consequences under the VEA, MRCA or general administrative law, depending on the conduct and the applicable statutory provisions outside this instrument. The Statement does not reference such sanctions or the processes for detecting false evidence.
• The instrument’s requirement for specific kinds of diagnostic evidence (histology or established imaging criteria, microbiological evidence for tuberculosis or atypical mycobacteria, colonoscopy timing records, and documentary evidence for inability to obtain appropriate management) means that inadequate or nonexistent supporting documentation will typically result in the decision-maker finding that a reasonable hypothesis has not been raised (s 6(2) Note 2; s 8). That outcome is enforced via claim refusal rather than by penalty under the Statement itself.

No enforcement discretion specified

• The Statement does not set out enforcement discretions, monitoring powers, or compliance reporting obligations. Its role is to provide determinative medical criteria for nexus assessments; subsequent enforcement or remedial action flows from decisions made under the VEA and MRCA frameworks.

This Statement is made under the authority of subsection 196B(2) of the Veterans' Entitlements Act 1986 (s 3) and expressly applies to claims to which VEA s 120A or MRCA s 338 apply (s 4). Its legal effect is therefore as an interpretive instrument within the statutory architecture of the VEA and the MRCA claims processes.

Relationship with VEA and MRCA

• The Statement is not a standalone entitlement instrument. It operates as a Statement of Principles that feeds into the statutory "reasonable hypothesis" test under VEA s 120A and MRCA s 338. Section 4 specifically ties the Statement’s application to claims under those sections, so the Statement’s criteria are relevant only within those statutory claim pathways.
• The Statement records that it was made pursuant to s 196B(2) of the VEA (s 3). As such, its determinants have force in the administrative assessment of claims under both Acts where the reasonable hypothesis threshold must be evaluated in relation to mesenteric panniculitis.

Interaction with other Statements of Principles

• Section 10 creates a cross-reference mechanism for overlap with other Statements of Principles determined under s 196B(2) of the VEA. If a factor in s 8 refers to an injury or disease that is already the subject of another Statement, then the factors in that other Statement apply according to its terms as in force from time to time. This establishes a precedence and coordination rule between SOPs where co-morbidity or causation involves another listed disease or injury.

Medical classification systems

• The Statement acknowledges the ICD‑10‑AM code K65.8 is assigned to mesenteric panniculitis but makes clear that, for the purpose of this Declaration, the statutory meaning is the textual definition in s 6(2) (s 6(3)). It cites the specific edition of ICD‑10‑AM and its publication details (s 6(4)), thereby linking the Statement to existing clinical classification frameworks but reserving the instrument’s textual definition as authoritative in claims contexts.

Limits with other legal instruments and clinical practice

• The instrument excludes certain conditions from the meaning of mesenteric panniculitis (s 6(2)(b)). Those exclusions can affect whether other legal or clinical instruments that reference those excluded conditions will intersect with claims under the VEA/MRCA for mesenteric panniculitis.
• Where a claimant’s presentation is primarily an excluded condition (for example retroperitoneal fibrosis or acute peritonitis), those injuries are outside the scope of this Statement. Any interaction with other laws or benefits that cover those excluded conditions will be governed by the instruments relevant to those conditions, not by this Statement.

Administrative law and review

• The Statement itself does not set review mechanisms. Decisions by authorities applying the Statement in the VEA or MRCA claims process remain subject to the review and appeals provisions of those Acts and to the general principles of administrative law. The Statement’s definitions and factors therefore become central evidentiary elements in any subsequent statutory or judicial review of decisions made under the parent legislation.

The instrument records its determination date as 27 April 2018 and commencement date as 28 May 2018 (cover sheet, s 2). It is identified as Statement of Principles No. 49 of 2018 concerning mesenteric panniculitis. No amendments, revocations or superseding Statements are recorded in the text provided.

What the instrument records

• Determination and execution: The cover pages and signatures show the instrument was made by the Repatriation Medical Authority and sealed at the direction of the Authority’s Chairperson on 27 April 2018 (cover sheet). The instrument’s commencement date is explicitly set at 28 May 2018 (s 2).
• Authority: The instrument states it is made under subsection 196B(2) of the VEA (s 3). It applies to claims brought under specified sections of the VEA and MRCA (s 4).

No recorded amendments within the instrument

• The text contains no amendment notes, no provision indicating amendment history within the instrument itself, and no expiry date. The absence of amendment history in the instrument means that any subsequent changes, if they exist, are not reflected here and must be located in later instruments or official registers.

How to track amendments in practice

• Because the Statement is framed as an instrument determined under s 196B(2) of the VEA and because s 10 contemplates other Statements in force from time to time, users should treat this document as a snapshot as at commencement date. Practitioners and claimants who rely on the Statement should confirm whether any later revisions, replacements or related Statements have been made by consulting the Repatriation Medical Authority’s instruments register, the Federal Register of Legislation, or the administrative records of the agency that processes VEA and MRCA claims.
• If a factor in s 8 refers to another injury or disease covered by a separate Statement of Principles, that other Statement may be amended independently and will apply "as in force from time to time" (s 10). This means that amendments to related SOPs can change the evidentiary landscape for claims involving multiple conditions.

Administrative practice note

• The Statement itself does not specify transitional arrangements for claims in progress at commencement. Practitioners should check departmental guidance or policy notes accompanying decisions under the VEA or MRCA to determine how the Statement has been operationalised in practice since 28 May 2018.

The instrument does not contain or reference any litigation history. It is a Statement of Principles determined by the Repatriation Medical Authority and contains no citations to cases, no references to judicial interpretations, and no internal account of contested applications or judicial review outcomes. Consequently, there is no litigation record within the instrument itself to summarise.

Potential for contest in the claims system

• The instrument sets out definitive factors that must exist as a minimum to raise a reasonable hypothesis connecting mesenteric panniculitis or death from it to relevant service (s 8). Administrative decisions applying these factors are subject to the statutory review and appeal mechanisms embedded in the VEA and MRCA frameworks. While the instrument does not record litigation, disputes may arise in practice about the interpretation and application of the factors, the sufficiency of medical evidence, the temporal limits in s 9(2), or whether a given clinical presentation falls within the exclusions of s 6(2)(b).
• The instrument’s statement that the Repatriation Medical Authority is "of the view that there is sound medical‑scientific evidence" (s 7) establishes an evidentiary predicate that decision-makers rely upon. Challenges could be expected where claimants or their advisers dispute either the RMA’s view or the application of the specified factors to individual facts. The instrument itself, though, does not document any such proceedings.

Points of likely contention (from the instrument)

• Diagnostic sufficiency: The instrument requires histology or imaging using established radiological criteria for diagnosis (Note 2 to s 6(2)). Litigated disputes could focus on whether particular imaging findings meet the "established radiological criteria" or whether a histological report is sufficiently specific.
• Exclusions and radiological ambiguity: The Statement excludes "misty mesentery" not specifically diagnosed as mesenteric panniculitis (s 6(2)(b)). Disputes may arise over whether an imaging report that uses descriptive language counts as a specific diagnosis.
• Temporal and causal limits: Section 9(2) restricts the application of some factors to diseases suffered or contracted before or during, but not arising out of, relevant service. The contours of that language could provoke contestation in individual claims about the timing and causal attribution of disease onset and aggravation.
• Cross-referencing other SOPs: Section 10 requires application of other Statements where factors refer to injuries or diseases already the subject of a Statement of Principles. Litigation or review matters might query which SOP applies where multiple SOPs intersect or where subsequent SOPs amend earlier factors.

Absent direct cases in the instrument

• Because the Statement contains no cases or reported litigation, anyone needing to know whether or how courts or tribunals have treated this Statement in specific disputes must search external judicial and administrative review records. The Statement itself supplies the legal predicates that would be argued in any such review but does not supply the outcomes.

This Statement contains several specific drafting choices and limitations that can materially affect claims. Practitioners must pay close attention to these points when advising claimants, assembling evidence, or preparing submissions.

1. Narrow list of qualifying factors (s 8)

• The instrument prescribes only four types of factors that, as a minimum, will raise the reasonable hypothesis: abdominal infection with tuberculosis or atypical mycobacteria at the time of clinical onset (s 8(1)), the same infection at the time of clinical worsening (s 8(2)), colonoscopy within 48 hours before clinical worsening for colon-only disease (s 8(3)), and inability to obtain appropriate clinical management (s 8(4)). If a claimant’s presentation does not include one of these factors, the Statement says a reasonable hypothesis has not been raised by virtue of other conditions not listed here. Practitioners must therefore map medical history to these discrete triggers rather than rely on more general claims about abdominal inflammation.

2. Temporal and causal restriction on s 8(2)-8(4) (s 9(2))

• The instrument’s s 9(2) states that subsections 8(2)-8(4) apply only where the disease was suffered or contracted before or during, but did not arise out of, relevant service. This phrasing creates a potentially counterintuitive limit: factors that refer to clinical worsening, colonoscopy timing, or inability to obtain management are not available for diseases that arose out of service. Practitioners must ascertain and document onset timing relative to service carefully. Where onset occurred after service or is said to have arisen out of service, s 8(2)-(4) may not be available pathways to raise a reasonable hypothesis.

3. Exclusions to the meaning of mesenteric panniculitis (s 6(2)(b))

• The instrument excludes several diagnoses and radiological phenomena from the statutory meaning. If a claimant’s records only show sclerosing encapsulating peritonitis, retroperitoneal fibrosis, peritoneal adhesions, acute or infectious peritonitis, or "misty mesentery" without a specific mesenteric panniculitis diagnosis, the Statement does not cover that presentation. Given the overlap of signs and imaging descriptors in abdominal disease, careful diagnostic clarification is essential.

4. Diagnostic standard and "established radiological criteria" (Note 2 to s 6(2))

• The Statement requires diagnosis by histology or by abdominal imaging using established radiological criteria. The instrument does not define which radiological criteria suffice, nor does it list specific imaging features. This lack of precision can make it difficult to determine whether particular imaging reports meet the instrument’s diagnostic test. Practitioners will need expert radiological opinions that explicitly link an imaging report to the "established criteria" referenced.

5. Colonoscopy timing requirement (s 8(3))

• For mesenteric panniculitis of the colon only, a colonoscopy within 48 hours before clinical worsening is a specified factor. The 48 hour window is rigidly expressed in the instrument. If colonoscopy occurred outside that window, the factor is not met. Practitioners should ensure colonoscopy timings are explicitly evidenced.

6. Requirement to show inability to obtain appropriate clinical management (s 8(4))

• The phrase "inability to obtain appropriate clinical management" is inherently factual and will turn on contemporaneous evidence of access problems, referrals, or service-related barriers. The instrument does not elaborate on what evidence suffices. Claimants relying on this factor must document attempts to obtain treatment and the reasons those attempts failed, and must link those failures to relevant service under s 9(1).

7. Death inclusion requires contribution to terminal event (s 6(5))

• Death from mesenteric panniculitis is covered only where the disease contributed to the person’s terminal event or condition. The Schedule defines terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). Practitioners must show contribution to the proximate or ultimate cause of death rather than merely the presence of mesenteric panniculitis.

8. Cross-reference to other SOPs can redirect the required evidence (s 10)

• If a factor in s 8 refers to another injury/disease that is the subject of its own SOP, then the other SOP’s factors apply. That may mean that evidence needs to be gathered to meet the requirements of another SOP rather than this Statement’s standalone factors. Practitioners must identify and apply the text of any referenced SOP as it is "in force from time to time" (s 10).

9. ICD code does not determine scope (s 6(3)-(4))

• Although an ICD‑10‑AM code exists for mesenteric panniculitis, the instrument makes the textual definition the operative meaning for claims. Do not rely on coding alone; the statutory definition controls.

10. Burden of proof and administrative thresholds implicit but not spelled out

• The Statement specifies minimal factors for raising a reasonable hypothesis; it does not specify the standard, weight or sufficiency of evidence, nor how competing medical opinions are to be resolved. Practitioners must therefore assemble robust, contemporaneous, and condition‑specific medical records and expert opinions to avoid evidentiary shortfalls.

This section sets out pragmatic, source‑grounded steps for claimants, clinicians and advisers preparing mesenteric panniculitis claims under the VEA s 120A or MRCA s 338 processes, using only the instrument’s requirements as the guide.

1. Confirm applicability to the claim

• Ensure the claim is one to which VEA s 120A or MRCA s 338 applies, because the Statement expressly applies only to claims within those statutory pathways (s 4). Confirm that the applicant’s service falls within the Schedule’s definition of "relevant service" (operational, peacekeeping, hazardous, British nuclear test defence under the VEA; warlike or non‑warlike under the MRCA) (Schedule 1).

2. Establish the diagnosis according to the Statement

• Obtain and collate diagnostic materials that match the instrument’s diagnostic routes: histology reports or abdominal imaging reports that explicitly reference established radiological criteria for mesenteric panniculitis (Note 2 to s 6(2)). Where diagnosis is based on imaging, obtain a radiologist’s report that states how the findings meet established radiological criteria. Avoid relying solely on non‑specific descriptors such as "misty mesentery" unless there is a clear, specific diagnostic statement of mesenteric panniculitis (s 6(2)(b)).

3. Identify which factor in s 8 you can establish

• Map the claimant’s medical history to the discrete factors in s 8 and gather the specific evidence required:
  • For s 8(1) or s 8(2): produce microbiology, pathology, clinical or hospital records demonstrating an abdominal infection with tuberculosis or atypical mycobacteria at the time of clinical onset or at the time of clinical worsening. Time-stamp the records to show concurrence of infection with onset/worsening.
  • For s 8(3): where mesenteric panniculitis involves the colon, produce endoscopy records demonstrating a colonoscopy occurred within the 48 hours prior to clinical worsening. Include procedural notes, timestamps, and contemporaneous clinical observations linking the colonoscopy and the subsequent worsening.
  • For s 8(4): document attempts to obtain appropriate clinical management and why they failed. This might include clinic referral attempts, service medical records showing denial or unavailability of care, written correspondence, and contemporaneous notes recording lack of access. The Statement does not define the evidence needed, so contemporaneous, specific documentation will be persuasive.

4. Satisfy the relationship to relevant service

• For any factor relied on, show the factor is related to the person’s relevant service (s 9(1)). For factors in s 8(2)-(4) confirm that the mesenteric panniculitis was suffered or contracted before or during, but did not arise out of, the relevant service (s 9(2)). That will require a clear timeline of symptom onset, prior diagnoses, and service dates. Assemble service records alongside clinical records to demonstrate temporal relationship.

5. Deal with exclusions and overlapping conditions

• If medical records show any of the conditions excluded in s 6(2)(b), address those explicitly. If a factor in s 8 refers to or implicates an injury or disease that is the subject of a different Statement of Principles, obtain that other Statement and follow its factors because s 10 requires the other Statement’s factors to apply "as in force from time to time." Collect evidence relevant to that SOP as well.

6. Prepare expert medical opinion that links facts to the Statement’s criteria

• Obtain a clear, reasoned medical opinion that addresses:
  • How the diagnosis meets the instrument’s diagnostic standard (histology or imaging criteria).
  • Which s 8 factor is present and the evidence that supports it.
  • How the factor is related to the person’s relevant service (s 9(1)), and, where applicable, how the disease was suffered/contracted before or during service but did not arise out of service (s 9(2)).
  • For death claims, whether mesenteric panniculitis contributed to the terminal event identified in the Schedule (s 6(5) and Schedule 1).

7. Chronology and packaging of evidence

• Prepare a succinct chronology that links service dates, symptom onset, diagnostic events (histology, imaging), microbiology results (TB or atypical mycobacteria), colonoscopy timing, and attempts to obtain care. The Statement’s factors hinge on timing and specific clinical events, so the chronology should make those connections explicit.

8. Anticipate evidentiary gaps and plan remediation

• Where imaging lacks the specific language of "established radiological criteria" or where microbiology reports are absent, obtain retrospective expert review that explains why existing reports meet the criteria or, if appropriate, seek additional testing or historical confirmation from hospital records. For access-to-care claims under s 8(4), contemporaneous service medical records, referral logs, or correspondence are likely to be critical.

9. Cross-check coding and documentation

• Do not assume ICD‑10‑AM coding alone suffices (s 6(3)-(4)). Use the code as supplementary evidence but ensure the textual diagnostic and clinical materials meet the Statement’s definitions.

10. Keep an eye on related SOPs and updates

• Because the Statement contemplates application of other Statements in force from time to time (s 10), and because amendments or new SOPs may alter the evidentiary landscape, practitioners should confirm whether this Statement remains unamended and whether other relevant SOPs exist or have been updated since the commencement date (s 2).

These steps follow directly from the instrument’s text. The central compliance task is to assemble evidence that maps to the instrument’s narrow, specified factors and to demonstrate the relationship of those factors to relevant service as the instrument demands (s 8-9).