Statement of Principles concerning morbid obesity (Reasonable Hypothesis) (No. 43 of 2022)

The instrument operates through a set of tightly defined concepts that govern how a reasonable hypothesis may be raised. Central concepts are morbid obesity, clinical onset and clinical worsening, relevant service, and specified antecedent factors.

• Morbid obesity: Defined expressly in s 7(2). For adults the criterion is BMI ≥ 40, using the BMI formula in the Schedule: BMI = W / H2 where W is weight in kilograms and H is height in metres (Schedule, BMI). For persons aged 18 years or younger the instrument uses a percentile benchmark: BMI at least 120 percent of the 97th percentile in the 2007 World Health Organisation BMI Charts by age and gender (s 7(2)). The Schedule confirms BMI calculation and cites the WHO charts for paediatric references.

• Death from morbid obesity: The SoP includes deaths where morbid obesity contributed to a terminal event (s 7(3)). The Schedule lists terminal events that are considered proximate or ultimate causes of death, including pneumonia, respiratory failure, cardiac arrest, circulatory failure or cessation of brain function (Schedule, terminal event).

• Reasonable hypothesis standard: The SoP is framed in terms of whether “a reasonable hypothesis has been raised” linking morbid obesity (or death from it) to relevant service. Section 9 establishes the minimum factual preconditions: at least one listed factor must exist before it can be said that a reasonable hypothesis is raised. Section 8 records the RMA’s view that sound medical‑scientific evidence supports potential links with relevant service; the SoP then operationalises that view through the enumerated factors.

• Factors for onset and worsening: The instrument separates factors relevant to the clinical onset of morbid obesity (ss 9(1)-(14)) from analogous factors that can cause clinical worsening of morbid obesity (ss 9(15)-(28)). Many factors are mirrored for onset and for worsening (for example, excessive caloric intake for at least five years applies to both onset (9(1)) and worsening (9(15))). Some factors are drug related: taking a specified drug for at least six months (9(2) and 9(16)), antipsychotic drugs for at least three months (9(3) and 9(17)), systemic glucocorticoid therapy at or above specified doses for at least three months (9(4) and 9(18)). The Schedule gives a conversion table of equivalent glucocorticoid doses (Schedule, equivalent glucocorticoid therapy).

• Mental health and eating disorders: The SoP recognises psychiatric and behavioural disorders as factors. Binge eating disorder and night eating syndrome are defined according to DSM‑5‑TR diagnostic criteria in the Schedule and must have been present for at least one year before onset/worsening (9(5), 9(19)). “Clinically significant disorder of mental health as specified” lists discrete conditions (anxiety disorder, bipolar disorder, depressive disorder, panic disorder, personality disorder, PTSD, schizophrenia, social phobia, specific phobia) and requires at least two years’ duration before onset/worsening (9(6), 9(20)).

• Sleep, shift work and smoking: Inability to sleep for an average of more than five hours per night for at least five years is a factor (9(10), 9(24)). Night shift work is defined in the Schedule as working at least three hours between midnight and 5 am and requires at least 500 occasions within a continuous five‑year period (9(11), 9(25)). Smoking cessation after a regular smoking habit is a factor: if a person with a prior regular smoking habit (defined as at least 5 pack‑years within a continuous five‑year period in the Schedule) permanently ceased smoking within two years before onset/worsening, that cessation is a factor (9(12), 9(26)).

• Alcohol: The SoP includes as a factor consumption of a cumulative total of at least 50 kilograms of alcohol from drinking beer within five years before onset/worsening (9(13), 9(27)). The Schedule notes alcohol consumption is to be calculated using the Australian standard of 10 grams of alcohol per standard drink. Converting units is therefore necessary to evidence this factor.

• Access to care: For clinical worsening only, inability to obtain appropriate clinical management for morbid obesity is included as a factor (9(28)). The instrument does not set the procedural test for proving that inability; it leaves that to application by decision‑makers.

• Relationship to other SoPs: If a factor refers to an injury or disease that is the subject of another SoP determined under s 196B(2), then that other SoP applies according to its own terms (s 11). This creates an interlocking system of SoPs where overlapping causes are governed by specialists’ statements.

The conceptual mechanics require factual evidence of durations, dose levels, and temporality relative to clinical onset or worsening, and require an explicit connection between the factor and relevant service (s 10(1)). The instrument is therefore both definitional and procedural in character: it defines thresholds and provides a checklist that triggers the reasonable‑hypothesis gateway for statutory claims decision‑makers.

The instrument speaks directly to several groups involved in the VEA and MRCA claims system. It affects veterans, members of Peacekeeping Forces, members of the Forces under the VEA, and members under the MRCA who lodge claims that fall under section 120A of the VEA or section 338 of the MRCA (s 5; Schedule, relevant service definitions). It also affects decision‑makers and medical assessors who adjudicate those claims, because the SoP is the medical framework they must use to determine whether a reasonable hypothesis connecting morbid obesity to relevant service has been raised.

Specific affected parties:

• Claimants: Veterans or service members making claims alleging morbid obesity or death from morbid obesity as service related. To engage the SoP they must show at least one factor listed in s 9 existed in the required temporal relationship to clinical onset or worsening, and that the factor was related to relevant service (s 10(1)). For worsening factors in ss 9(15)-(28), the morbid obesity must have been suffered or contracted before or during (but not arising out of) relevant service (s 10(2)).

• Medical experts and treating clinicians: The SoP relies on clinical measures (BMI calculations, DSM‑5‑TR diagnoses for certain eating and mental disorders, evidence of medication use and doses, sleep history, alcohol and tobacco consumption, service rosters for night shift work). Clinicians must provide records addressing the precise thresholds and durations set out (eg, antipsychotic for at least three months, equivalent glucocorticoid doses for at least three months). The Schedule provides exact diagnostic and pharmacological parameters the clinician’s evidence must address.

• Administrators and decision‑makers under the VEA/MRCA: Decision‑makers are required to apply the SoP when considering whether a reasonable hypothesis has been raised. Section 11 also directs administrators to defer to other SoPs when a factor refers to an injury or disease already subject to another SoP. The instrument therefore affects the evidentiary framework and the causal queries decision‑makers will pose.

• Legal advisers, advocates and medical‑legal reporting services: Practitioners preparing or responding to claims must gather and present evidence matching the SoP’s thresholds (duration, doses, BMI, DSM criteria, smoking pack‑years, night shift records, alcohol calculations, evidence of access to clinical management). The Schedule’s technical definitions constrain what evidence will meet the SoP’s minimum requirements.

• Families and estates where death is claimed: The instrument covers death from morbid obesity where morbid obesity contributed to a terminal event (s 7(3)). Estates seeking entitlements must be able to link morbid obesity, via at least one s 9 factor, to relevant service and show the contribution to a terminal event (Schedule, terminal event list).

Who does not get directly altered rights by the instrument: the SoP itself does not create new monetary entitlements or penalties; it is a determinative medical statement used within the statutory claims architecture of VEA and MRCA. It therefore does not, by itself, alter benefit schedules or create enforcement mechanisms. However, by setting methodological thresholds it can materially influence which claims will pass the “reasonable hypothesis” gate and progress to substantive entitlements under the VEA or MRCA frameworks.

The instrument itself does not create civil penalties or criminal offences. It creates practical duties on decision‑makers and procedural rights for claimants by specifying the medical criteria that must be satisfied to raise a reasonable hypothesis that morbid obesity (or death from it) is connected to relevant service.

Key duties:

• Duty of decision‑makers to apply the SoP: As an RMA SoP determined under s 196B(2) of the VEA and made to apply to claims under s 120A VEA or s 338 MRCA (s 5), the document functions as the authoritative medical framework that decision‑makers should use to assess causation. Section 11 further requires that if a factor refers to another condition covered by a different SoP, the other SoP applies as in force from time to time.

• Duty to establish temporal and service connection: The decision to accept a reasonable hypothesis depends on finding that at least one factor in s 9 existed in the required period before clinical onset or worsening and was related to relevant service (s 9 and s 10(1)). For factors addressing worsening of pre‑existing morbid obesity, decision‑makers must ensure that the morbid obesity was suffered or contracted before or during relevant service (s 10(2)).

• Duty to interpret Schedule definitions: Administrators and medical assessors must interpret and apply the technical definitions in Schedule 1 when assessing evidence (for example, computing pack‑years, applying DSM‑5‑TR criteria, converting glucocorticoid doses using the table).

Key rights and practical entitlements for claimants:

• Right to have a claim considered under this SoP: A claimant whose claim falls under s 120A VEA or s 338 MRCA has the right to have the RMA’s morbid obesity SoP applied in adjudicating whether a reasonable hypothesis exists.

• Right to rely on the enumerated factors as minimum thresholds: If a claimant adduces credible evidence that at least one of the factors in s 9 existed in the stated temporal relationship and that the factor is related to relevant service, the SoP creates the minimum factual foundation to raise a reasonable hypothesis. That is a procedural right to progress the claim to the next stage of merits assessment.

• Right to have overlapping conditions assessed according to other SoPs: Section 11 provides that where a factor refers to a disease covered by another SoP, that other SoP applies. This is a right to potentially rely on the more specific or differing terms of another RMA SoP.

Evidence‑related duties imposed on claimants (practical rather than express statutory obligations):

• Provide medical evidence that matches the specified durations and thresholds (eg, medication records evidencing at least six months of a specified drug as per s 9(2)/(16); antipsychotic prescription for at least three months as per s 9(3)/(17); prednisone or equivalent dosing meeting or exceeding the table thresholds for at least three months as per s 9(4)/(18) and Schedule equivalent glucocorticoid therapy).

• Demonstrate temporality: define the clinical onset and/or clinical worsening dates and show the factor predated those events for the stated durations.

What the SoP does not do:

• The instrument does not itself confer payment, specify pension amounts, or set appeal or review procedures. Those matters remain governed by the VEA and MRCA statutory frameworks and administrative processes.

• The SoP does not prescribe how decision‑makers are to resolve competing inferences about causation beyond the requirement that at least one factor exists and be related to relevant service. The standard remains the "reasonable hypothesis" gateway; the SoP sets the minimal factual building blocks for that hypothesis.

All duties and rights described are grounded in the body of the SoP: see ss 5, 7-11 and Schedule 1.

The document contains no penal clauses, fines, or criminal offences. It is an administrative medical instrument intended for use in claims assessment under the VEA and MRCA. The SoP does not prescribe sanctions for non‑compliance nor does it create enforcement mechanisms; instead its operative effect is evidentiary and procedural within the statutory entitlement system.

How enforcement operates in practice, as derived from the instrument:

• Administrative effect: The SoP functions as the RMA’s authoritative medical view. Decision‑makers administering entitlements under the VEA and MRCA must apply SoPs when considering whether a reasonable hypothesis exists. Any enforcement therefore is internal to the claims administration process: a claimant who cannot meet the thresholds in the SoP will not have a reasonable hypothesis established and, consequently, the claim may not proceed to determination of causation and benefits under the relevant Acts.

• No direct sanctions: The instrument does not authorise regulatory action (for example, suspension of benefits, fines or disciplinary measures) by reference to the SoP itself. Any such measures would need to be grounded in the substantive provisions of the VEA or MRCA, not the SoP.

• Evidentiary consequences: The SoP’s definitions and thresholds specify what evidence is relevant; not meeting those evidentiary thresholds functionally prevents a claimant from establishing the required reasonable hypothesis. In that sense, the instrument exercises indirect enforcement of evidentiary standards: e.g., not having records of medication, BMI history, or service rosters will impede satisfying the SoP’s criteria.

• Interaction with other proceedings: The instrument does not address litigation, appeals or review procedures. Where a claimant’s claim is rejected or accepted on the basis of applying the SoP, subsequent administrative review or judicial review processes available under the VEA/MRCA frameworks would be the mechanisms by which parties seek enforcement or challenge decisions. The SoP itself contains no guidance on those processes.

• Repeal and substitution: The instrument expressly repeals the prior SoP No. 5 of 2014 (s 4). For administrative systems, that change can affect pending claims insofar as the operative SoP changes the evidentiary thresholds; the instrument itself contains no transitional or retrospective application clause, so administrators must rely on the governing statutory rules and any administrative instructions on transition.

In summary, enforcement is procedural and administrative: the SoP supplies standards which adjudicators use; failure to meet those standards will result in an unfavourable claim outcome, but the instrument imposes no fines, penalties, or criminal liability.

This Statement of Principles is an instrument made under subsection 196B(2) of the Veterans' Entitlements Act 1986 (s 3). It is not a freestanding statute. Its legal effect is to supply medical‑causation guidance to decision‑makers adjudicating claims under the VEA and the MRCA where those claims fall within specified sections (s 5). Key interactions:

• VEA and MRCA claims framework: The SoP is intended to be applied to claims to which section 120A of the VEA or section 338 of the MRCA applies (s 5). Those sections in the parent Acts set the statutory framework in which a “reasonable hypothesis” of service connection is required to move a claim forward. The SoP does not change statutory entitlements but provides the RMA’s medical view to inform statutory decisions about causation.

• Other RMA SoPs: Section 11 establishes an internal hierarchy and coordination among SoPs. If a factor in this morbid obesity SoP refers to an injury or disease covered by another SoP determined under s 196B(2) of the VEA, then the factors in that other SoP apply in accordance with its terms. This creates cross‑referencing: for example, if a factor refers to Cushing syndrome or hypothyroidism and there is a separate SoP for those conditions, administrators should apply that other SoP’s criteria where relevant. The instrument therefore functions within an integrated RMA SoP ecosystem.

• Diagnostic standards and medical texts: The SoP explicitly references and requires use of DSM‑5‑TR diagnostic criteria for binge eating disorder and night eating syndrome (Schedule). That means medical assessments and expert reports prepared for claims need to use DSM‑5‑TR standards. The Schedule also references the 2007 WHO BMI Charts for age and gender for paediatric BMI thresholds. Applying the SoP therefore imports those external medical standards into the statutory causation analysis.

• Pharmaceutical dose equivalence: The Schedule provides a conversion table for equivalent glucocorticoid therapy, specifying minimum average doses for particular agents (eg, prednisolone 5 mg/day) that constitute the threshold for the glucocorticoid factor (Schedule, equivalent glucocorticoid therapy). Decision‑makers must therefore apply those dose thresholds when evaluating medication records.

• Evidence requirements implicit in statutory process: The SoP’s temporal thresholds (for example, five years of excessive caloric intake before onset; three months of antipsychotic use; 500 night shift occasions within five years) interact with evidence law and administrative procedures. Medical records, employment rosters, pharmacy dispensing histories, and allied documentation are the primary evidence types that will be used within claims processes governed by the parent Acts.

• No conflict with other statutory provisions: The SoP does not purport to override or amend substantive provisions of the VEA or MRCA. It is a medical instrument applying within the statutory causation framework; any substantive benefits, eligibility, or appeals remain governed by the parent Acts and their procedures.

• Repeal of previous SoP: The 2022 instrument expressly repeals the prior morbid obesity SoP No. 5 of 2014 (s 4). That repeal means that assessments undertaken after commencement should apply the 2022 SoP, subject to any transitional directions in the administrative scheme. The instrument does not itself prescribe transition rules; interaction with transitional or savings provisions requires reference to administrative guidance and the parent Acts.

What the instrument does not address that may still be governed elsewhere:

• It does not provide rules about the standard of proof beyond the reasonable hypothesis gateway; it does not prescribe how the merits decision is then to be made if a reasonable hypothesis is raised. Those questions are governed by the VEA and MRCA and their administrative and review mechanisms.

• It does not address compensation schedules, quantification of loss, or medical treatment entitlements; those matters remain part of the VEA/MRCA statutory and regulatory regimes.

All cross‑legal interactions referred to are grounded in the instrument’s own operative text: see ss 3, 5, 8, 9, 10 and 11, and Schedule 1.

This instrument is dated 29 April 2022, commences on 30 May 2022, and expressly repeals the prior Statement of Principles concerning morbid obesity No. 5 of 2014 (Federal Register of Legislation No. F2014L00010) which had been made under subsections 196B(2) and (8) of the VEA (s 4). The instrument does not list any other amending instruments or earlier variations. The immediate amendment history evident from the text is therefore:

• Repeal of SoP No. 5 of 2014 (s 4). The 2022 instrument replaces the 2014 SoP as the operative RMA statement on morbid obesity.

• New or revised definitions and factors: Comparing the 2022 text with the 2014 instrument would be necessary to identify substantive substantive changes in thresholds, enumerated factors, and definitions. The instrument itself does not include a table of changes or explanatory memorandum within the provided text, nor does it include transitional application clauses. The Schedule 1 definitions in this instrument set the operative meanings for terms such as binge eating disorder defined expressly from DSM‑5‑TR criteria, the glucocorticoid equivalence table, and the listing of specified drugs.

• Commencement: The instrument has a clear commencement date (30 May 2022) (s 2). There is no express retrospective or savings provision in the text provided. Administrative practice will determine whether claims lodged before commencement are to be assessed under the prior or new SoP; the instrument itself does not state transitional directions.

• Source authority: The instrument is made under subsection 196B(2) of the VEA (s 3). No further amending instruments are recorded in this text.

Where practitioners need up‑to‑date application: Because the instrument can be superseded by later RMA SoPs or amendments, practitioners should verify on the Federal Register of Legislation or the RMA website whether any subsequent variation, amendment, or repeal has occurred after 29 April 2022. The instrument’s own text supports only the single alteration recorded: repeal of the 2014 SoP and commencement of the 2022 SoP on the stated date.

The instrument itself does not record litigation nor refer to any judicial decisions. There are no cases named in the text. The RMA’s statement that it is “of the view that there is sound medical‑scientific evidence” (s 8) is a factual assertion about the evidence base, not a legal citation to case law. Therefore:

• No litigation is referenced in this SoP. The instrument contains no judicial or tribunal decisions, no references to precedent, and no reported case law within the text provided.

• Consequence for practitioners: Any litigation or administrative appeals concerning the application of this SoP will be recorded in tribunal or court databases, but the SoP text itself provides no litigation history to rely on. Practitioners should search the Administrative Appeals Tribunal decisions, Federal Court or Federal Circuit Court decisions and published determinations for any disputes where this SoP has been applied or challenged since its commencement.

• Use in disputes: The SoP is intended to be a determinative medical instrument used by decision‑makers. If a claimant’s case progresses to review or judicial review following an administrative decision that applied or failed to apply the SoP, relevant decisions may interpret or challenge how the SoP’s factors were applied. However, the instrument itself contains no record of such litigation.

In short, within the text supplied, there is no litigation history to cite. Practitioners must consult external legal databases for any case law applying or interpreting this SoP post‑commencement.

The instrument contains a number of precise thresholds, definitional choices and cross‑references that create practical pitfalls for claimants and advisers. These are areas where small evidentiary errors or misconstructions can be determinative.

• Temporal thresholds and establishing the clinical onset/worsening date: The SoP requires that particular factors existed for specified durations before the clinical onset or clinical worsening (for instance, caloric excess for at least five years before onset, antipsychotic use for at least three months before onset, and so on (s 9)). Determining the date of clinical onset or clinical worsening is therefore central. The instrument does not define “clinical onset” or “clinical worsening” in the Schedule; those are clinical determinations. A failure to identify and document these dates precisely will impede meeting the SoP’s durations.

• BMI calculation and paediatric percentile rule: The adult threshold is BMI ≥ 40 (s 7(2); Schedule BMI). For those aged 18 or under the criterion is BMI of at least 120 percent of the 97th percentile on the 2007 WHO BMI Charts. Practical issues: historical records may not have contemporaneous WHO percentile calculations; clinicians must retroactively compute percentiles using the 2007 charts. Mistakes in height measurement or weight history will materially affect eligibility under the SoP.

• Alcohol measure expressed in kilograms: The instrument requires having consumed a cumulative total of at least 50 kilograms of alcohol from drinking beer within five years before onset or worsening (ss 9(13), 9(27)). The Schedule directs that alcohol consumption is calculated using the Australian standard of 10 grams per standard drink. Converting 50 kilograms (50,000 grams) into standard drinks yields 5,000 standard drinks over five years (50,000 grams / 10 grams per drink = 5,000 drinks). That is an unusually large quantity and may raise issues of interpretation (for example whether “50 kilograms of alcohol from drinking beer” is a drafting choice meaning 50 kg of beer rather than 50 kg of pure alcohol). The instrument text as provided is explicit in its language; therefore practitioners must carefully calculate and document consumption and be prepared to address unit interpretation issues in submissions.

• Specified list of drugs and scope surprises: The Schedule’s list of specified drugs includes a broad range of agents not traditionally associated in public discussion with weight gain (eg, insulin, propranolol, progesterone‑only contraceptives, sulfonylureas, thiazolidinediones) (Schedule, specified list). Practitioners should not assume “specified drugs” means only a few psychiatric agents; the list is exhaustive for these purposes and requires six months’ exposure for the factor to apply (s 9(2), 9(16)). For some agents (for example insulin), the medication may be part of managing metabolic conditions that also independently affect weight; documenting causal pathways and temporality is important.

• Glucocorticoid equivalence: The prednisone threshold is set at 5 mg/day (s 9(4), 9(18)), but the Schedule supplies conversion minima for other glucocorticoids (eg betamethasone 0.8 mg; dexamethasone 0.8 mg; hydrocortisone 20 mg). Medical records must show average daily dosing at or above those thresholds for at least three months. Pharmacy dispensing records alone may not specify average daily dosing; practitioners should supply expert interpretation.

• Night shift work threshold: To trigger the night shift factor the person must have worked on at least 500 occasions of night shift within a continuous period of at least five years, and night shift is defined as working at least three hours between midnight and 5 am (s 9(11), 9(25); Schedule night shift work). This is an objectively high threshold requiring employment records or rostering data; casual or intermittent claims will often fail.

• Smoking cessation and pack‑year thresholds: A “regular smoking habit as specified” means at least 5 pack‑years within a continuous five‑year period (Schedule). The smoking cessation factor is only engaged where the person permanently ceased smoking within two years before clinical onset/worsening (s 9(12), 9(26)). Claimants who reduced rather than permanently ceased, or who smoked at lower intensity, may not meet the pack‑year threshold. Calculation of pack‑years requires precise history: cigarettes per day averaged over time multiplied by years smoked.

• Mental health disorder thresholds: The SoP requires “clinically significant disorder of mental health as specified” to have been present for at least two years before clinical onset/worsening (s 9(6), 9(20)). The Schedule notes that ongoing management may involve regular visits, but it also clarifies that “warrants ongoing management does not require that any actual management was received” (Schedule, clinically significant disorder: Notes 1-2). This wording can cause disputes: absence of documented management is not decisive, but establishing that a condition was of sufficient severity to warrant ongoing management will normally require medical records or expert opinion.

• Inability to obtain appropriate clinical management: The worsening factor at s 9(28) is open‑ended. Demonstrating “inability to obtain appropriate clinical management” will require documentary proof of referrals, waitlist evidence, geographic or service‑access barriers, or other evidence. The SoP provides no more granular standard; disputation is likely over what counts as inability and what is “appropriate” management.

• Overlap with other SoPs: Section 11 means that if a factor refers to an injury or disease for which another SoP exists, that other SoP applies. Practitioners must search for and apply the relevant SoP rather than relying solely on the morbid obesity SoP where overlap exists (for example, where hypothyroidism or Cushing syndrome is implicated and has its own SoP).

• No penalty or remedy language: Because the SoP is evidentiary, failing to meet one or more factors results not in sanction but in failure to establish the reasonable hypothesis. Practitioners need to present thorough evidence rather than rely on general clinical impressions.

These are concrete application hazards. In practice the “gotchas” arise from the numerical and diagnostic thresholds in the SoP and from the burden of proving temporality and service relatedness (s 10(1)). Advisors should plan documentary searches and expert reports that address the specific Schedule definitions.

Compliance in this context means preparing and presenting evidence that aligns precisely with the SoP’s requirements so that a reasonable hypothesis is raised that morbid obesity (or death from morbid obesity) is connected to relevant service. Below are concrete, source‑grounded steps advisers should take for claimants and their representatives. Each step maps to the relevant provisions.

1. Establish that the claim falls within the SoP’s remit (s 5)

   • Confirm the claim is one to which section 120A of the VEA or section 338 of the MRCA applies. If it does, this SoP is an applicable RMA instrument for causation.

2. Define and document clinical onset and/or clinical worsening dates

   • Work with treating clinicians to set a clear clinical onset date and any dates of clinically significant worsening. The durations required for nearly every factor are counted backwards from these dates (s 9). Where possible obtain contemporaneous clinical notes documenting the first presentation and any subsequent deterioration.

3. Prove BMI thresholds or paediatric percentile

   • For adults, calculate BMI as per Schedule: BMI = weight (kg) / height (m)2. Establish that BMI reached or exceeded 40 before the claimed onset/worsening (s 7(2); Schedule BMI). For persons aged 18 or younger, compute BMI against the 2007 WHO BMI Charts to show BMI ≥ 120% of the 97th percentile (s 7(2)). Obtain clinical measurements, hospital notes, or allied health records.

4. Address death claims with terminal event linkage

   • If claiming death from morbid obesity, secure the death certificate and relevant medical records showing morbid obesity contributed to a terminal event listed in the Schedule (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) (s 7(3); Schedule terminal event).

5. Document medication use and doses

   • For the specified list of drugs (s 9(2)/(16); Schedule specified list), compile pharmacy dispensing histories and prescriber notes proving at least six months’ use prior to onset/worsening.
   • For antipsychotics, demonstrate at least three months’ use prior to onset/worsening (s 9(3)/(17)).
   • For systemic glucocorticoids, prove average daily dosing at or above the equivalence thresholds in Schedule (eg prednisolone 5 mg/day) for at least three months (s 9(4)/(18); Schedule equivalent glucocorticoid therapy). Where dosing records are ambiguous, supply an endocrinologist’s or pharmacologist’s expert conversion.

6. Evidence psychiatric/eating disorder factors under DSM‑5‑TR

   • For binge eating disorder and night eating syndrome, obtain psychiatric assessment using DSM‑5‑TR criteria as the Schedule requires; show duration of at least one year before onset/worsening (s 9(5)/(19); Schedule binge eating disorder and night eating syndrome).
   • For clinically significant mental disorders listed in the Schedule, obtain treating notes, diagnostic reports, and where available records of ongoing management to support a two‑year duration before onset/worsening (s 9(6)/(20); Schedule clinically significant disorder).

7. Sleep and shift work evidence

   • For the sleep factor, obtain sleep studies, GP or specialist notes, or patient logs demonstrating inability to obtain more than five hours’ average sleep per night for at least five years (s 9(10)/(24)).
   • For night shift work, collect employer rosters, payroll, or statutory declarations documenting at least 500 night shift occasions within a continuous five‑year period where “night shift” is working at least three hours between 12 am and 5 am (s 9(11)/(25); Schedule night shift work).

8. Smoking history and cessation

   • To engage the smoking cessation factor, document a prior regular smoking habit of at least 5 pack‑years within a continuous five‑year period (Schedule one pack‑year and regular smoking habit definitions). Then show permanent cessation occurred within two years before onset/worsening (s 9(12)/(26)). Use clinical notes, quit program records, or corroborated histories.

9. Alcohol calculation

   • For the beer consumption factor, compute cumulative alcohol consumption in grams and convert using the Australian standard of 10 g per standard drink as the Schedule prescribes, and show at least 50,000 g (50 kg) of alcohol from beer within five years before onset/worsening (s 9(13)/(27); Schedule alcohol note). Because the unit is unusual, provide clear arithmetic and supporting beverage consumption records or corroborating statements.

10. Severe childhood abuse

    • For severe childhood abuse (s 9(14)), collect child protection, police, medical or social work records; where unavailable, consider corroborative evidence such as contemporaneous medical notes, statements from third parties, or psychological expert assessment. The Schedule defines severe childhood abuse with particular perpetrator categories which should be explicitly tied to the evidence.

11. Inability to obtain appropriate clinical management

    • Where relying on s 9(28) (clinical worsening factor), gather referral letters, waitlist notices, distance and availability evidence, correspondence showing denial or delay of bariatric or other appropriate services, and expert opinion on what constitutes appropriate management in the claimant’s clinical circumstances.

12. Address service relatedness (s 10(1))

    • The SoP requires that the existence of the factor must be “related to the relevant service” (s 10(1)). Establish the connection between the factor and the service: this can involve linking service duties to exposure (eg night shift rosters during deployments), showing service‑related medication exposure, or explaining how service circumstances caused or contributed to the factor (eg, service trauma precipitating a mental disorder). Provide service records, deployment summaries, unit rosters or supervisor statements as needed.

13. Cross‑referencing other SoPs (s 11)

    • If a factor refers to another condition covered by another SoP (for example, Cushing syndrome, hypothyroidism or trauma causing hypothalamic damage), obtain and apply the relevant SoP’s criteria as s 11 directs. Ensure the other SoP is current and include its terms in submissions.

14. Use expert reports targeted to SoP thresholds

    • Commission medical experts (endocrinologists, psychiatrists, sleep specialists, pharmacologists, forensic physicians) to address the SoP’s specific thresholds: exact doses, durations, DSM‑5‑TR diagnostic criteria, BMI percentiles, inability to obtain care, and the nexus to service. Experts should explicitly state whether the SoP’s factor is met on the balance of probabilities and why, referencing the SoP paragraphs.

15. Prepare for unit conversion and precise arithmetic

    • The Schedule requires specific conversions (BMI formula, pack‑year calculations, glucocorticoid equivalence, alcohol standard). Ensure arithmetic is explicit and reproducible in submissions.

16. Anticipate cross‑examination and evidence gaps

    • Where a factor is borderline (eg 4.5 years of caloric excess when 5 years is required), try to identify supplementary evidence that may bring the claimed period within the threshold or identify alternative factors that do meet thresholds. For factors reliant on subjective history (eg caloric intake excessive for energy needs), supplement with nutritional assessments and corroborative evidence.

17. Record retention and chronology

    • Maintain a chronological, indexed bundle that maps each evidentiary item to the specific SoP paragraph it is intended to satisfy. This reduces the risk that a decision‑maker will say a factor was not proved because the evidence was not framed against the SoP criteria.

These steps derive from the instrument’s operative text and Schedule definitions: see ss 5, 7-11 and Schedule 1. The SoP’s precision demands correspondingly precise documentary and expert preparation.