Statement of Principles concerning multiple sclerosis (Reasonable Hypothesis) (No. 11 of 2020)

The SoP rests on a small set of structural concepts that determine how it is applied in practice.

Reasonable hypothesis and evidentiary role: The instrument specifies the factors which, in the RMA’s view, constitute sound medical‑scientific evidence that may raise a reasonable hypothesis connecting multiple sclerosis (MS) or death from MS with relevant service. The instrument itself does not articulate procedural steps from the VEA or MRCA for adjudication, but it functions as the medical‑scientific input to the statutory test referenced in those Acts (see s3, s8, s9). The phrase “reasonable hypothesis” is employed in s9 as the threshold for connection; the instrument lists the factors that must exist, in conjunction with a link to relevant service (s9; s10(1)).

Defined medical entity and exclusions: The instrument defines multiple sclerosis in substantive clinical terms, describing it as “a chronic relapsing‑remitting or progressive disorder affecting the motor and sensory systems of the central nervous system” with characteristic demyelination, inflammation and gliosis occurring on multiple occasions (s7(2)(a)). It explicitly includes relapsing‑remitting, primary progressive and secondary progressive multiple sclerosis (s7(2)(b)). The instrument also lists close differential diagnoses that are excluded: clinically isolated syndrome, radiologically isolated syndrome, neuromyelitis optica, acute disseminated encephalomyelitis, Marburg disease, Balo concentric sclerosis and Schilder disease (s7(2)(c)). The instrument notes the ICD‑10‑AM code G35 applies but states the special definitional wording of s7(2) governs application (s7(3)-(4)).

Onset versus worsening, and timing rules: The SoP divides factors into those that may be relevant to clinical onset and those relevant to clinical worsening. Sections 9(1)-9(10) primarily address pre‑onset exposures and states; subsections 9(11)-9(26) set out factors that can materially contribute to or aggravate MS (s9). Section 10(2) clarifies that subsections 9(11)-9(26) apply only when the person’s MS was suffered or contracted before or during their relevant service (i.e. the person already had MS during service and the factor materially contributed to or aggravated the condition).

Quantified thresholds and operational definitions: Many factors contain precise thresholds for intensity, duration or timing. Examples include smoking at least five pack‑years before onset (or within five years of cessation) (s9(2)); exposure to second‑hand smoke for at least 10,000 hours before onset (s9(3)); organic solvent exposure on more days than not for at least one continuous year (s9(4)); vitamin D deficiency defined as serum 25‑hydroxyvitamin D <50 nmol/L for a continuous period of at least one year for onset‑relevant factor (s9(7)); and cumulative equivalent ionising radiation dose of at least 10 sieverts to the affected site for worsening (s9(24)). The Schedule defines terms such as “pack‑years”, “being overweight” (BMI ≥25), “specified sunlight exposure levels” and the methodology reference for dose reconstruction (Schedule 1).

Interplay with other SoPs and external materials: The instrument incorporates cross‑references. If a listed factor refers to an injury or disease that is the subject of another SoP, that other SoP’s factors apply in accordance with its terms (s11). The instrument also references external classification and guidance materials: ICD‑10‑AM (specific edition effective 1 July 2017) for code cross‑reference (s7(3)-(4)); and the ARPANSA Guide to calculation of 'cumulative equivalent dose' for ionising radiation dose reconstruction (Schedule 1).

Death and terminal events: Death from multiple sclerosis is included: the instrument treats multiple sclerosis as including death from a terminal event or condition that was contributed to by the person's MS, and the Schedule defines “terminal event” with examples such as pneumonia, respiratory failure and cardiac arrest (s7(5), Schedule 1).

Administrative reach: The instrument explicitly applies to claims under sections of the VEA and MRCA referenced in s5. It is therefore aimed at providing the medical basis for administrative decision‑making in the veterans’ compensation and rehabilitation context (s5, s3). The RMA states its view that sound medical‑scientific evidence supports the proposition that MS and death from MS can be related to relevant service (s8).

Collectively, these main concepts show the instrument is a rulebook of exposure and clinical‑timing criteria that administrative decision‑makers, treating clinicians and claimants must map onto available records to determine whether the “reasonable hypothesis” step has been met for MS claims.

Primary populations: The instrument is intended to affect persons making claims under the VEA or MRCA frameworks where section 120A of the VEA or section 338 of the MRCA are engaged (s5). The RMA’s view in s8 expressly situates the instrument in the context of relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the MRCA. Practically, the primary affected groups are:

• former or current Australian Defence Force members or personnel with qualifying relevant service seeking entitlements for multiple sclerosis or death from multiple sclerosis under the VEA or MRCA;
• administrators and decision‑makers within the Department of Veterans’ Affairs and other statutory decision bodies who must apply the SoP in adjudicating claims; and
• medical and allied health practitioners preparing medical evidence for claimants or for the decision-maker’s use.

Claimant cohorts and dependency on service history: The instrument requires that any factor relied upon be related to the person’s relevant service (s10(1)). That ties application to the service history categories defined in the Schedule: operational service, peacekeeping service, hazardous service, British nuclear test defence service, warlike service and non‑warlike service (Schedule 1). The instrument therefore primarily affects claimants able to show relevant service under those categories; the exact types of service and the procedural implications are governed by the VEA and MRCA provisions cited in s5.

Decision-makers and expert witnesses: Administrative decision-makers must apply the SoP when considering whether a reasonable hypothesis exists. They will need to interpret and verify exposures, timing and thresholds against the Schedule’s definitions and referenced external materials (for example, ICD‑10‑AM and the ARPANSA guide for ionising radiation dose reconstruction) (s7(3)-(4); Schedule 1). Medical experts preparing opinions for claimants or for the department will need to address the specific thresholds and durations (s9, Schedule 1) in their reports.

Indirectly affected parties: Employers, unit commanders, medical records custodians and other third parties may be drawn into the evidentiary process because the SoP requires documentary proof of exposures or events. Examples include workplace records for organic solvent exposure, rosters for second‑hand smoke hours, pharmacy and hospital records for immunomodulatory therapies and hormonal assisted reproductive therapy, laboratory records for vitamin D levels, and radiation dose histories requiring dose reconstruction methodology cited in the Schedule (s9(4), s9(5), s9(7), s9(8), s9(23)-(24); Schedule 1).

Class exclusions: People with conditions explicitly excluded from the definition of multiple sclerosis in s7(2)(c) , for example, neuromyelitis optica or clinically isolated syndrome , are not within the instrument’s scope for MS claims. However, if a listed factor refers to another disease which has its own SoP, the cross‑application rule in s11 brings that other SoP into play.

Administrative costs and service providers: Because the instrument requires specific tests, durations and dose calculations (for example vitamin D serial lab values; ARPANSA dose reconstruction), there is an administrative and clinical cost for claimants and the decision-maker to assemble the evidence required to meet thresholds (s9, Schedule 1). Health providers will be asked to provide objective, often numerical, evidence mapped to the Schedule definitions.

In summary, the instrument primarily affects veterans and service personnel claiming MS-related entitlements under the VEA/MRCA, the decision-makers who apply the SoP, and the clinicians and institutions that must provide the precise medical and exposure evidence required by the SoP’s thresholds and definitions.

The instrument itself does not create criminal duties or private civil liabilities; rather, it prescribes the medical criteria that decision-makers should use when assessing whether a reasonable hypothesis exists that links multiple sclerosis or death from multiple sclerosis to relevant service. Key operative duties and rights in practice arise from the interplay between this SoP and the VEA/MRCA administrative framework.

Duty of the Repatriation Medical Authority: The instrument is made under subsection 196B(2) of the VEA (s3). The Authority’s statutory function under that provision is to determine Statements of Principles. The instrument records the Authority’s view that sound medical‑scientific evidence exists supporting a relationship between MS and relevant service (s8). The SoP itself sets out the Authority’s medical determinations and thresholds; it does not itself instruct the decision-maker on procedural steps, but it functions as the authoritative medical statement to guide adjudication.

Duty of decision-makers to apply the SoP: While this instrument does not restate the statutory obligations of the departmental decision-makers under the VEA or MRCA, it applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (s5). In practice, decision-makers will use the SoP to determine whether the medical‑scientific threshold for a reasonable hypothesis has been met. The decision‑maker’s duty will be to evaluate whether at least one of the factors in s9 exists and is related to relevant service (s9; s10(1)). Subsections 9(11)-9(26) are limited to claims of material contribution or aggravation where MS pre‑existed before or during service (s10(2)), a factual parameter decision-makers must enforce.

Rights of claimants: Individuals making claims under the VEA/MRCA have the right to have the SoP considered in their applications. The SoP provides definitive, clause‑based criteria (for example, minimum pack‑year smoking history, minimum hours of second‑hand smoke exposure, laboratory thresholds for vitamin D levels) that a claimant may use to demonstrate a reasonable hypothesis. Claimants have the practical right to present medical and occupational evidence addressing the precise thresholds in s9 and the Schedule 1 definitions.

Obligations on evidence producers: Clinicians, laboratories and other records custodians have the practical obligation to provide evidence mapped to the SoP where requested. Examples include laboratory data showing serial serum 25‑hydroxyvitamin D levels (s9(7)), medication records showing dates of immune checkpoint inhibitor therapy (s9(8), s9(16)), or occupational exposure records to support organic solvent exposure on “more days than not” for at least one continuous year (s9(4)). The Schedule references external methodology for radiation dose calculation (ARPANSA Guide), and duty-holders preparing dose reconstructions must apply that methodology if ionising radiation is relied upon (Schedule 1).

Cross‑application of other SoPs: Section 11 requires that, where a factor in s9 refers to another injury or disease covered by a different SoP, the factors in that other SoP apply in accordance with its terms (s11). Decision-makers must therefore identify and apply the correct cross-referenced SoP criteria when factor evidence involves another injury or disease.

Limitations on applicability: The instrument establishes application boundaries. Subsection 10(2) limits certain factors to material contribution/aggravation contexts where MS pre-existed before or during service; the definition of multiple sclerosis in subsection 7(2) excludes certain demyelinating disorders (s7(2)(c)); and the instrument’s explicit adoption of its own clinical meaning takes priority over simple ICD coding (s7(3)). These are effectively constraints decision-makers must respect.

No penal provisions: The SoP contains no penalty regime or criminal sanctions. Its function is evaluative and administrative rather than punitive.

In aggregate, the instrument creates an evidentiary framework which imposes practical duties on decision-makers to apply medical thresholds, and on claimants and medical evidence providers to produce the specific, often numerical, documentation needed to satisfy those thresholds. The rights are procedural: claimants may rely on the SoP’s criteria as the medical test for raising a reasonable hypothesis connecting MS or death from MS with relevant service.

The Statement of Principles does not create direct civil penalties, criminal offences or monetary fines. It is not framed as a statute imposing sanctions; instead, it is an evidentiary instrument used within the administrative regimes established by the VEA and the MRCA (s3, s5). Enforcement therefore occurs through administrative decision-making rather than through penal enforcement attached to this instrument itself.

Administrative enforcement within compensation framework: The practical effect of the SoP is enforced when departmental decision-makers determine whether a claimant has raised a reasonable hypothesis linking MS (or death from MS) to relevant service for the purposes of entitlements under the VEA/MRCA (s5). If a decision-maker finds the SoP’s criteria satisfied and other legal elements are met under the primary Acts, the claimant may obtain entitlements. Conversely, if the SoP’s factors are not met, the claimant’s claim may be rejected or fail at that medical causation threshold. The instrument therefore has de facto enforcement impact on entitlement outcomes, albeit exercised through administrative decision-making under the parent statutes.

No express sanction for false evidence in this instrument: The SoP does not specify consequences for provision of false or misleading evidence. Any sanctions in that context would derive from the VEA, MRCA, general administrative law, or criminal law (for example, fraud or false statements) rather than from this instrument itself. The instrument’s Schedule requires objective, quantifiable measures for many factors (for example lab test thresholds, numeric exposure durations) which shifts focus toward verifiable documentary evidence in adjudication (s9; Schedule 1).

Burden on decision-makers and evidentiary standards: Enforcement risks for administrators include the need to verify retrospective exposures and durations , second‑hand smoke hours, pack‑years, continuous periods of vitamin D deficiency, radiation dose reconstructions , using records that may be incomplete or imprecise (s9, Schedule 1). The instrument implicitly places a burden on decision-makers to interpret and weigh numerical thresholds and documentary evidence against the SoP’s criteria. Administrative appeals and merits review mechanisms available under the VEA/MRCA regime may follow from unfavourable decisions, but those appeal pathways are outside the instrument text.

References to external guidance with enforcement implications: The Schedule references the ARPANSA methodology for calculation of cumulative equivalent dose to organs or tissues for ionising radiation (Schedule 1). Where ionising radiation exposure is relied upon, dose reconstruction must be calculated “in accordance with the methodology set out” in that guide, which operationally ties an external technical standard to the instrument. Decision-makers and dose reconstruction professionals will need to enforce conformity to that methodology when assessing ionising radiation factors (Schedule 1).

No civil indemnities or fee changes: The instrument does not include provisions modifying the cost of claims processing, fee exemptions, or indemnities for the State or third parties. Any budgetary or procedural changes arising from the instrument will be implemented through the departments administering the VEA/MRCA rather than by the SoP itself.

In short, the SoP’s “enforcement” is exercised through administrative determinations made under the VEA/MRCA framework. It creates measurable hurdles that, if not satisfied, affect a claimant’s entitlement prospects, but it contains no standalone penalty regime or criminal sanctions.

The SoP is a statutory instrument made under subsection 196B(2) of the VEA (s3) and expressly applies to claims to which certain provisions of the VEA and MRCA apply (s5). Its interaction with other laws occurs primarily in three ways: (1) reliance by VEA/MRCA decision-making processes; (2) cross‑reference to other Statements of Principles; and (3) dependency on external technical standards and classification systems.

Integration with the VEA and MRCA claims framework: The instrument applies to claims that fall under section 120A of the VEA or section 338 of the MRCA (s5). Those sections, which are not reproduced in this instrument, set out the statutory entitlement mechanisms to which the medical‑scientific test (reasonable hypothesis) feeds. The SoP therefore functions as the RMA’s authoritative medical evidence for the causation component of those statutory tests. Decision-makers under the VEA/MRCA will consult this SoP when determining whether the medical threshold of a reasonable hypothesis is satisfied for MS-related claims.

Cross-application with other Statements of Principles: Section 11 provides a specific legal interaction rule: where a factor in s9 refers to an injury or disease that is the subject of another SoP determined under subsection 196B(2) of the VEA, then the factors in that other SoP apply in accordance with its terms (s11). This mandates that decision-makers must identify when a listed factor implicates a different disease or injury and then apply the other SoP’s criteria rather than attempting to treat the factor in isolation. For example, if a factor relates to a named infectious disease or a radiation exposure condition with its own SoP, the decision-maker must apply that separate SoP as in force.

References to external classification and technical guidance: The instrument references the ICD‑10‑AM code G35 for multiple sclerosis but makes clear that the substantive definition in s7(2) governs application (s7(3)-(4)). The instrument also ties ionising radiation dose calculation to the ARPANSA Guide referenced in Schedule 1, stating cumulative equivalent dose is to be calculated “in accordance with the methodology set out in the Guide … as in force on 2 August 2017” (Schedule 1). These references mean that the SoP’s application requires importation of external legal and technical materials, and that changes to those materials may affect application: for ICD coding, a decision-maker must be attentive to the specified edition; for radiation dose reconstructions, the stated guide and date govern methodology.

Overlap with other statutory or clinical obligations: While the instrument itself does not alter clinical practice guidelines or occupational health standards, its thresholds (for example, specified sunlight exposure levels, vitamin D thresholds, pack‑year definitions, and BMI cut-offs) will shape what evidence is collected and supplied in the VEA/MRCA claims context. For employers, health services and clinicians, the SoP’s requirements may lead to requests for records or assessments that intersect with privacy, records access and public health legislation, although those legislative interactions are external to this instrument.

Temporal and territorial interaction: The instrument commences on a fixed date (23 March 2020), and it repeals the prior SoP (s4). That temporal sequencing means claims lodged after commencement will be assessed against this SoP, replacing the prior SoP. The SoP’s cited external materials specify editions and effective dates (for example, the ICD‑10‑AM Tenth Edition, effective 1 July 2017), so practitioners must ensure they use the referenced versions when applying the instrument (s7(4)).

No displacement of common law or unrelated statutory causes of action: The SoP does not purport to displace causal or evidentiary rules in unrelated areas of law. Its effect is limited to administrative application within the VEA/MRCA entitlement regimes. Private law claims, workplace compensation schemes or other statutory compensation frameworks are not amended by this instrument unless those schemes themselves require or adopt the RMA SoPs.

In summary, the SoP functions as a medical‑scientific input to the statutory adjudicative machinery of the VEA and MRCA, mandates cross‑application of other SoPs where relevant, and requires use of specified external classification and technical guidance when particular factors (for example, ionising radiation) are relied upon.

This instrument is dated 28 February 2020 and commenced on 23 March 2020 (s1, s2). It is identified as the Statement of Principles concerning multiple sclerosis (Reasonable Hypothesis) (No. 11 of 2020) (s1). The instrument expressly repeals the prior Statement of Principles concerning multiple sclerosis No. 100 of 2011, which was made under subsections 196B(2) and (8) of the VEA and had Federal Register of Legislation number F2011L01736 (s4). No other amendments, schedules of modification, transitional provisions or subsequent amendments are contained within the instrument text provided.

Implications of the repeal and replacement: By repealing the 2011 SoP, the 2020 instrument replaces the earlier medical‑scientific criteria with the factors, thresholds and definitions contained in this instrument (s4). The document therefore represents the RMA’s up‑to‑date position as at its date of determination and commencement. Users must apply the 2020 instrument for claims to which section 120A of the VEA or section 338 of the MRCA applies from the commencement date (s2, s5).

External references with edition dates: The instrument references external materials with specified editions and effective dates that are relevant to application. For example, subsection 7(4) identifies the ICD‑10‑AM Tenth Edition effective 1 July 2017 for code cross‑reference (s7(4)). The Schedule refers to the ARPANSA Guide “as in force on 2 August 2017” for methodology on calculation of cumulative equivalent dose for ionising radiation exposures (Schedule 1). These dated references are part of the instrument’s content and may constrain the applicability of newer editions unless the SoP is amended.

No recorded subsequent amendments in this text: The instrument as provided contains no later amendment notes, revocations, consultations, or legislative history beyond the repeal of the 2011 SoP and the adoption and commencement dates. If there have been later RMA determinations or legislative changes affecting the SoP since the commencement date, those are not contained in the text provided and would need to be checked against the Federal Register of Legislation and subsequent RMA determinations.

Practical effect for historically active claims: Because the instrument replaced the previous SoP, claimants and decision-makers must account for temporal application rules under the VEA/MRCA to determine whether a particular claim should be assessed under the 2011 SoP or the 2020 SoP. The instrument itself provides no transitional provisions, so the applicable SoP will be determined by the statutory and administrative rules of the parent Acts and departmental practice (s4, s5).

In sum, the amendment history within this document is limited and explicit: it is a replacement SoP dated 2020 that repeals and supersedes the 2011 SoP, with commencement set 23 March 2020. Any further amendments or repeals after that date are not recorded in the text supplied.

The Statement of Principles document itself does not cite or summarise any case law, judicial determinations or appeal outcomes. The instrument contains no references to litigation, judicial interpretation, or past decisions that have applied or tested the prior or current SoP; it therefore supplies no litigation history within its own text.

What the instrument does provide is the RMA’s medical‑scientific view (s8) and an evidentiary framework for administrative determinations under the VEA and MRCA. The existence of this instrument means that litigation in the veterans’ entitlement system , administrative appeals, merits review, or judicial review , could potentially engage the SoP as part of challenged decisions. However, this instrument does not record any such litigation outcomes, nor does it cite judicial authority or interpretive guidance.

Practical implication for advisors: Because the SoP contains precise thresholds and definitions, decisions applying the SoP may give rise to disputes about fact‑finding (for example, whether a claimant has 10,000 hours of second‑hand smoke exposure, whether a continuous vitamin D deficiency of under 50 nmol/L for one year can be demonstrated, or whether ionising radiation dose reconstruction meets the ARPANSA methodology). These fact patterns are likely to feature in administrative appeals, but any such litigation outcomes are not included in this instrument and must be located in external administrative tribunal or court records.

No cases named in the instrument: The instrument names no cases. It does not identify litigated questions about the meaning of “reasonable hypothesis”, the weight to be given to particular factors, or the interaction of the SoP with other statutory provisions. Users seeking litigation history or precedents applying this SoP will therefore need to search tribunal decisions and court judgments applying the VEA/MRCA and RMA SoPs after the commencement date.

In short, the instrument contains no litigation history. Its deployment in the administrative process can be expected to generate contested decisions that may enter the tribunal and judicial review system, but any such outcomes must be sourced from the external case law and administrative decisions databases rather than from this document.

The SoP contains many specific thresholds and cross-references that create potential pitfalls for claimants, advisers and decision-makers. The following are concrete practical issues to watch for, grounded directly in the instrument.

Onset versus worsening: The instrument differentiates factors relevant to clinical onset from those relevant to clinical worsening, and subsection 10(2) restricts subsections 9(11)-9(26) to situations of material contribution to, or aggravation of, MS where the person’s MS was suffered or contracted before or during relevant service. Misclassification of whether a factor is being relied upon for onset or for worsening can lead to improper application of time windows and applicability constraints (s9; s10(2)).

Proving temporal continuity: Several factors require continuous periods. For example, vitamin D deficiency requires serum 25‑hydroxyvitamin D <50 nmol/L for a continuous period of at least one year before clinical onset, with additional timing requirements if deficiency occurred more than two years before onset (s9(7)). Demonstrating continuous laboratory values over a year can be difficult if periodic testing is sparse. Similarly, “inhaling an organic solvent or having cutaneous contact … on more days than not for a continuous period of at least one year” requires a granular occupational exposure history (s9(4)).

Quantified exposure thresholds that are hard to evidence: The instrument sets numerical thresholds that may be difficult to document retrospectively:

• Second‑hand smoke: at least 10,000 hours (s9(3), Schedule 1). Translating employment or living arrangements into cumulative hours requires precise records.
• Pack‑years: at least five pack‑years before onset, or five pack‑years before clinical worsening (s9(2), s9(12)); the definition equates one pack‑year to 7,300 tailor‑made cigarettes and provides weight and cigarette equivalences in the Schedule, but historical smoking records may be imprecise.
• Overweight: being overweight (BMI ≥25) for at least five years when aged less than 30 years, with the five‑year period occurring within the 15 years before onset (s9(9), Schedule 1). Evidence of weight across adolescence and early adulthood may be lacking.

Reliance on external technical guidance: For ionising radiation, cumulative equivalent dose must be calculated in accordance with the ARPANSA Guide “as in force on 2 August 2017” (Schedule 1). Practitioners must ensure they use that specific methodology; alternative dose reconstruction approaches may not satisfy the instrument’s requirement (s9(24), Schedule 1).

Exclusions and differential diagnoses: The instrument excludes a number of demyelinating disorders from its definition of multiple sclerosis (s7(2)(c)). Mistakenly treating an excluded condition (for example, neuromyelitis optica) as MS in a claim will fail the SoP’s definitional requirement. Also, the instrument states that while MS attracts ICD‑10‑AM code G35, its meaning is that in s7(2) , so reliance purely on coding without meeting the instrument’s clinical definition may be insufficient (s7(3)).

Cross‑reference complexity: Section 11 requires that if a factor refers to an injury or disease covered by another SoP, the other SoP’s factors apply. Practitioners must identify and apply the correct external SoP in the precise terms it is in force; failing to do so can lead to incorrect conclusions (s11).

Vague but significant factors: Some factors are qualitative and can be operationally difficult to prove. For example, “inability to obtain appropriate clinical management for multiple sclerosis” is listed in s9(26) with no quantitative threshold. Establishing what constitutes “appropriate clinical management” and proving inability to obtain it will involve factual and evidentiary disputes.

Gender‑specific factor: Hormonal assisted reproductive therapy is a factor that applies to women only and has a three‑month timing window before clinical worsening (s9(22), Schedule 1). Advisers must be attentive to the gendered scope and time window when framing evidence.

Therapies and drug exposures: The instrument lists specific therapeutic agents and drug classes with precise timing windows for risk association: tumour necrosis factor alpha antagonists within two years before clinical onset or worsening (s9(5), s9(14)); immune checkpoint inhibitors within four months (s9(8), s9(16)); granulocyte colony‑stimulating factor or interferon within one year before worsening (s9(15)). Medication records must provide dates and regimens; ambiguous or incomplete prescribing records may impede satisfaction of the factor.

Death from MS includes contribution to terminal events: The instrument treats MS as including death from a terminal event that was contributed to by the person’s MS, and Schedule 1 provides a non‑exhaustive list of terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) (s7(5), Schedule 1). Medical causation linking MS to the terminal event must be demonstrated.

ICD code cannot override definition: Although MS attracts ICD‑10‑AM code G35, the instrument states the meaning of MS for this SoP is the definition in s7(2). Practitioners must ensure clinical features satisfy that definition rather than relying solely on ICD coding (s7(3)).

Temporal commencement and repeal: The instrument repealed the 2011 SoP and commenced on 23 March 2020 (s2, s4). Advisers must be careful to determine which SoP applies to a given claim depending on timing and procedural rules under the parent Acts.

In short, the SoP’s many specific thresholds and definitional constraints create evidentiary and procedural pitfalls. For each factor relied upon, advisers must plan contemporaneous or reconstructed evidence that aligns with the instrument’s precise wording and external methodology references.

For claimants, medical practitioners and decision-makers working within the VEA/MRCA framework, compliance with this SoP requires assembling and presenting evidence that maps directly to the factors and definitions in sections 7-11 and in Schedule 1. The following concrete steps, grounded in the instrument’s text, set out what compliance entails.

1. Identify the correct legal pathway and SoP application

• Confirm the claim falls within the scope of section 120A of the VEA or section 338 of the MRCA, as required by s5. If a claim is within those statutory provisions, this SoP applies.
• Check whether the claimant’s MS diagnosis conforms to the instrument’s clinical definition in s7(2). Do not rely solely on ICD‑10‑AM coding (s7(3)-(4)).

2. Establish whether you are addressing onset or worsening

• Decide whether the claim concerns clinical onset of MS or clinical worsening. Factors in s9 are partitioned; subsections 9(11)-9(26) apply only to material contribution to, or aggravation of, MS where the person’s MS was suffered or contracted before or during relevant service (s10(2)). Misclassification alters applicable time windows and factor applicability.

3. Map evidence to specific factors and thresholds

• For smoking: calculate pack‑years using the Schedule definition (one pack‑year = 20 tailor‑made cigarettes per day for one year = 7,300 cigarettes) and show at least five pack‑years before clinical onset or before worsening (s9(2), s9(12); Schedule 1). If cessation occurred, prove clinical onset/worsening occurred within five years of cessation (s9(2), s9(12)).
• For second‑hand smoke: document cumulative hours in enclosed spaces to reach at least 10,000 hours before onset or before worsening (s9(3), s9(13); Schedule 1 defines exposure).
• For organic solvent exposure: obtain occupational/environmental records demonstrating inhalation or cutaneous contact on “more days than not” over a continuous period of at least one year before onset (s9(4)).
• For immunomodulatory and oncologic therapies: secure pharmacy, hospital or prescribing records confirming specific agents and dates: tumour necrosis factor alpha antagonists within two years (s9(5), s9(14)); immune checkpoint inhibitors within four months (s9(8), s9(16)); granulocyte colony‑stimulating factor or interferon within one year before worsening (s9(15)); and note the Schedule examples for immune checkpoint inhibitors.
• For vitamin D: provide serial serum 25‑hydroxyvitamin D results showing <50 nmol/L for a continuous year before clinical onset, and demonstrate whether deficiency occurred more than two years before onset to apply timing rules (s9(7)).
• For sunlight exposure: document inability to meet the “specified sunlight exposure levels” for at least one year before onset, with timing conditions for exposures occurring more than two years before onset; use the specified sunlight exposure table in Schedule 1 (s9(6); Schedule 1).
• For overweight/BMI: document weight and height records to calculate BMI (BMI = W/H2) and demonstrate BMI ≥25 for at least five years when aged under 30 years, with that five‑year period occurring within the 15 years before onset (s9(9); Schedule 1).
• For infections and stressful events: assemble medical records for infections proximate to worsening (onset within five weeks before or two weeks after clinical worsening) (s9(11)); document stressful events per the Schedule definitions of category 1A, 1B and 2 stressors and the six‑month window for worsening (s9(17)-(20); Schedule 1).
• For reproductive therapy: for women, obtain records of hormonal assisted reproductive therapy within three months before clinical worsening (s9(22); Schedule 1).
• For ionising radiation: engage dose reconstruction specialists to apply the ARPANSA Guide “as in force on 2 August 2017” to calculate cumulative equivalent dose to the affected site; demonstrate at least 10 sieverts for the affected site to meet s9(24) (Schedule 1).

4. Address definitional precision and excluded conditions

• Ensure the condition meets the instrument’s clinical definition of multiple sclerosis and is not one of the excluded entities in s7(2)(c). If a factor refers to another disease for which an SoP exists, obtain and apply that other SoP per s11.

5. Prepare medico‑legal evidence that references the SoP

• Medical reports and expert opinions should explicitly map findings and exposures to the relevant SoP subsections and Schedule definitions, showing how numerical thresholds and timing windows are met (for example, cite s9(2) for smoking pack‑years, s9(7) for vitamin D levels, Schedule definitions for specified sunlight exposure).
• For ionising radiation, include a dose reconstruction that adheres to the ARPANSA methodology cited in the Schedule.

6. Document attempts to obtain care where s9(26) is relied upon

• If “inability to obtain appropriate clinical management for multiple sclerosis” (s9(26)) is relied upon, document attempts to obtain care, referrals, wait times, refusals, distances, or other barriers.

7. Preserve service and exposure records

• Gather service records showing the type of relevant service (operational, peacekeeping, hazardous, British nuclear test defence, warlike or non‑warlike as defined in Schedule 1) so that any factor can be linked to service per s10(1). Provide employment and unit records where occupational exposures are claimed.

8. Anticipate cross‑SoP interactions

• If a factor implicates another disease or injury covered by a separate SoP, obtain and comply with that SoP’s requirements (s11). Decision-makers must be informed of any such cross-reference.

9. Where records are lacking, consider reconstruction and corroborative evidence

• For exposures like second‑hand smoke hours or historical BMI, use corroborative sources , employment rosters, accommodation histories, statements from colleagues, photographic evidence, and contemporaneous medical notes , to reconstruct exposure timelines that meet the thresholds.

10. Engage technical expertise early for specialised factors

• For ionising radiation, engage appropriately qualified radiation dosimetrists to produce a report complying with the ARPANSA Guide (Schedule 1). For toxic exposures (organic solvents) and occupational histories, consider occupational medicine specialists to opine on exposure intensity and duration.

11. Keep the instrument version in view

• Use this SoP (No. 11 of 2020) for claims falling within its commencement scope (s2, s4). If a factor refers to an external code or guide, ensure the specified edition and effective date are used (s7(4); Schedule 1).

12. Prepare for administrative scrutiny and appeals

• Because the SoP sets quantified thresholds, be ready to present clear documentary support. Ambiguities are likely to be contested in the administrative process; meticulous documentation aligned with the SoP reduces risk of adverse findings.

Following these steps aligns the claimant’s and adviser’s evidence to the instrument’s precise wording and thresholds, thereby placing the administrative decision-maker in a position to assess whether a reasonable hypothesis has been raised under the VEA/MRCA evidentiary regime.