Statement of Principles concerning non-Hodgkin lymphoma (Reasonable Hypothesis) (No. 90 of 2018)

The instrument pivots on several tightly‑defined legal and medical concepts. These control how decision‑makers assess evidence and whether the statutory threshold of a “reasonable hypothesis” is met.

• Non‑Hodgkin lymphoma (NHL): The SoP defines NHL as a heterogeneous group of malignant lymphoproliferative diseases originating from T and B lymphocytes, presenting as solid tumours of the immune system that lack Reed‑Sternberg cells (s 7(2)(a)). The instrument expressly includes specific subtypes (Burkitt lymphoma, mycosis fungoides, adult T cell lymphoma/leukaemia and NHL arising within parenchymal organs) and expressly excludes myeloma, hairy cell leukaemia, Waldenström macroglobulinaemia, acute lymphoblastic leukaemia and chronic lymphocytic leukaemia/small lymphocytic lymphoma (s 7(2)(b)-(c)). The instrument also treats death from NHL as including terminal events or conditions contributed to by NHL (s 7(3)); “terminal event” is defined in the Dictionary.

• Reasonable hypothesis: The SoP does not define the legal standard of “reasonable hypothesis” itself; it provides the factual predicates (the factors in s 9) that, if present and related to relevant service, suffice to raise that hypothesis for claim assessment purposes under the VEA/MRCA (see s 5 and the statement at s 9 heading). The RMA records its view that there is sound medical‑scientific evidence to support relationships between NHL and relevant service (s 8).

• Relevant service: The Dictionary defines “relevant service” broadly to include multiple categories under the VEA and MRCA: operational service, peacekeeping service, hazardous service, British nuclear test defence service, warlike service and non‑warlike service (Schedule 1). The Vietnam‑related factor (s 9(18)) is tied to the Schedule 2 VEA descriptions for service in specified Vietnam areas/times (Schedule 1 definition of “being on land in Vietnam; or at sea in Vietnamese waters”).

• Factors and thresholds: Section 9 enumerates 33 distinct factors of varying types: infectious agents present at or before clinical onset (HIV, HTLV‑1, H. pylori, EBV, KSHV, Campylobacter jejuni, Chlamydia psittaci, Borrelia spp., hepatitis B/C, Plasmodium falciparum); medical histories (transplantation, Hodgkin’s lymphoma, autoimmune diseases in a specified list); drug exposures (systemic immunosuppressives from a specified list, hydrochlorothiazide for certain subtypes); occupational/environmental/chemical exposures with explicit quantitative thresholds (phenoxy acid herbicide exposure: cumulative 1,000 hours within a consecutive ten years and first exposure at least five years before onset (s 9(17)); benzene exposure thresholds measured by either cumulative hours with an ambient TWA >5 ppm (s 9(20)) or >10 ppm‑years cumulative exposure (s 9(21)); ethylene oxide 2,500 hours within ten years (s 9(22)); pentachlorophenol and other specified chemicals with 1,000‑hour thresholds and timing requirements); ionising radiation cumulative equivalent dose to bone marrow of at least 0.1 sievert (s 9(24)); obesity defined as BMI ≥30 for five years in the 20 years before onset (s 9(23)); and others). Many factors impose both duration/cumulative exposure requirements and minimum latency (first exposure at least five years before clinical onset).

• Temporal anchor , “clinical onset”: Many of the timing and latency thresholds use “the clinical onset of non‑Hodgkin lymphoma” as the anchor point (see multiple paragraphs in s 9). Establishing the clinical onset date will therefore be consequential for proving timing thresholds and latency windows.

• Subtype‑specificity: Several factors apply only to specific NHL subtypes (e.g. Richter syndrome s 9(5); adult T‑cell leukaemia‑lymphoma s 9(6); gastric and splenic marginal zone lymphoma s 9(7); primary effusion lymphoma and KSHV‑positive diffuse large B‑cell lymphoma s 9(9); small intestinal MALT lymphoma s 9(10); ocular adnexal MALT lymphoma s 9(11); cutaneous MALT lymphoma s 9(12); Burkitt lymphoma s 9(15); diffuse large B‑cell lymphoma s 9(25); anaplastic large cell lymphoma of the breast s 9(26); T‑cell lymphoma s 9(30); mycosis fungoides/Sezary syndrome s 9(32)). The SoP therefore requires accurate pathological classification and diagnosis to identify applicability of subtype‑limited factors.

• Cross‑reference to other SoPs: Where a factor in s 9 refers to an injury or disease covered by another SoP, that other SoP’s factors apply as in force from time to time (s 11). This makes the assessment of some factors contingent on separate Statements of Principles.

• Definitions and methodologies: The Schedule 1 Dictionary establishes measurement conventions (BMI formula, ppm‑years, 8‑hour time‑weighted average) and refers to external methodology for dose reconstruction for cumulative equivalent dose (ARPANSA Guide as in force on 2 August 2017). The SoP therefore anchors some technical assessments to external scientific methodology.

These concepts make the SoP a rules‑based instrument that turns clinical, exposure and service‑record evidence into an administrable threshold for raising a reasonable hypothesis in claims under the VEA and MRCA.

Primary persons affected by this instrument are claimants seeking entitlement under the VEA or MRCA where the claim concerns non‑Hodgkin lymphoma or death from non‑Hodgkin lymphoma. The instrument applies specifically to claims covered by section 120A of the VEA or section 338 of the MRCA (s 5). Relevant categories of people include:

• Veterans and former members of the Australian Defence Force who meet the statutory definitions of relevant service under the VEA (operational service, peacekeeping service, hazardous service, British nuclear test defence service) or under the MRCA (warlike or non‑warlike service); the Dictionary sets out the inclusive list for “relevant service” (Schedule 1).

• Members or former members of Peacekeeping Forces and members of the Forces under the MRCA, where those persons lodge claims for NHL or death from NHL under the identified claim pathways (s 8 references veterans, Peacekeeping Forces, and members under VEA/MRCA).

• Claim preparers, lawyers, medical practitioners and forensic experts who provide evidence in support of claims: the SoP defines evidentiary thresholds and measurement frameworks (for example, exposure thresholds, BMI and radiation dose reconstruction methodology) that will shape the types of evidence required.

• Decision‑making bodies and adjudicators under the VEA and MRCA: the instrument is intended to be used by decision‑makers applying s 120A VEA/s 338 MRCA to decide whether a reasonable hypothesis connects the condition to relevant service (s 5).

Affected stakeholders are not limited to individual claimants. The SoP has operational consequences for administrative bodies (Department of Veterans’ Affairs and related tribunals or appeal bodies) that process these claims. The instrument imposes an evidentiary regime that requires those agencies to obtain, evaluate and reconcile medical, service and exposure evidence against the SoP’s technical thresholds (for example, calculating ppm‑years, reconstructing cumulative equivalent radiation doses using the ARPANSA guide cited in the Dictionary).

The factors listed also affect employers, unit commanders and record‑keeping bodies insofar as documentation of exposures, deployments, medical prescriptions, surgical implants, service locations (for example, Vietnam land/sea service per Schedule 2 of the VEA), and access to clinical management will be relevant. For example, proving exposure thresholds for benzene or ethylene oxide will commonly require occupational exposure records or contemporaneous monitoring data; proving presence in Vietnam for at least 30 cumulative days will require service records tied to the Schedule 2 VEA descriptions referenced in the Dictionary.

Finally, the instrument affects medical certifiers and laboratories because many listed factors depend on contemporaneous clinical evidence or laboratory confirmation of infection at time of clinical onset (e.g. HIV, HTLV‑1, H. pylori, EBV, KSHV, hepatitis B/C, Campylobacter jejuni, Chlamydia psittaci, Borrelia spp., Plasmodium falciparum) or accurate histopathological subtyping of NHL (s 7(2), s 9 subparagraphs).

The Statement of Principles is an administrative evidentiary instrument and does not, on its face, impose criminal penalties or civil liabilities; rather it establishes the medical‑scientific facts that decision‑makers use to determine whether a “reasonable hypothesis” connects NHL to relevant service. Key legal duties and rights, as they follow from the instrument, include the following.

Duties and procedural obligations

• Duty of decision‑makers to apply the SoP when assessing claims that fall within s 120A VEA or s 338 MRCA: the instrument is specified to apply to claims caught by those provisions (s 5). While the SoP itself does not prescribe the full decision process under the Acts, it frames the factual predicates that decision‑makers must evaluate.

• Duty on claimants/proponents to adduce evidence that satisfies the listed factor(s): by setting the rule “at least one of the following factors must as a minimum exist” (s 9), the SoP effectively requires claimants to produce evidence that one or more enumerated factors existed and were related to the person’s relevant service (s 10(1)). The SoP specifies quantitative and temporal thresholds for many factors, so claimants bear the evidentiary task of showing those thresholds are satisfied.

• Duty to show relationship to relevant service: s 10(1) requires that the existence of any factor referred to in s 9 “must be related to the relevant service rendered by the person.” The instrument does not specify the standard of proof for that relationship; it sets the condition that relation to service is a necessary element for the SoP to operate.

Rights and decision consequences

• Right to have a claim assessed against the RMA‑determined factors: the SoP supplies the benchmark for whether a reasonable hypothesis exists; claimants are therefore entitled to have their medical, exposure and service evidence measured against the factors in s 9.

• Cross‑application of other SoPs where applicable: if a factor in s 9 refers to an injury or disease covered under another SoP determined under s 196B(2) of the VEA, then the other SoP’s factors apply “in accordance with the terms of that Statement of Principles as in force from time to time” (s 11). This is a procedural right for claimants to have interconnected conditions assessed under the applicable SoPs.

Limitations and qualifications

• Subtype and timing limitations: many factors only apply to specific NHL subtypes or impose minimum latency or duration thresholds (see s 9 particulars). For example, some insect/parasite/infection factors require that the infection be present at the time of clinical onset (see s 9(1), s 9(6)-(16) etc.). The s 9(33) factor , inability to obtain appropriate clinical management , is restricted by s 10(2) to cases where the NHL was suffered or contracted before or during, but did not arise out of, the person’s relevant service; it therefore does not apply to new NHL that arose out of service.

• Reliance on external methodology: the Dictionary defines “cumulative equivalent dose” with reference to an ARPANSA guide as in force on 2 August 2017, which decision‑makers will need to use for radiation dose reconstructions (Schedule 1 definition). This places an operational duty on decision‑makers (and indirectly on claimants) to use specified technical methodologies.

Legal form and legal effect

• The SoP is a statutory instrument made under s 196B(2) VEA (s 3). It is not itself the VEA or MRCA statutory entitlement; rather it is an authoritative medical‑scientific determination the RMA makes to inform administrative decisions under those Acts. The instrument’s legal effect is therefore as an evidentiary standard used by decision‑makers in applying the entitlement provisions in the VEA/MRCA.

In short, duties turn on the obligation to demonstrate one or more listed factors and their relationship to relevant service; rights include the entitlement to have claims judged against these RMA‑specified factors and, where relevant, to have interrelated SoPs applied in tandem.

The SoP itself does not create criminal offences or civil penalties. There are no penal provisions, sanction schedules, fines, or enforcement mechanisms included in the text of the instrument. Its operation is administrative and evidentiary: it supplies factors used by decision‑makers when assessing claims under the VEA and MRCA (s 5). The instrument’s enforcement consequences therefore arise indirectly through the statutory claim processes in the VEA and MRCA rather than through any penalties embedded in the SoP.

Concrete enforcement and compliance consequences are therefore administrative:

• Claim outcomes: If a decision‑maker, applying the VEA or MRCA, determines that none of the s 9 factors exists or that a factor existing is not related to the person’s relevant service (s 10), then a claim will not meet the RMA’s SoP threshold for raising a reasonable hypothesis under the relevant statutory provision. The likely practical consequence is refusal of an entitlement decision that depends on raising that hypothesis, subject to the usual merits review and appeal pathways provided in the VEA/MRCA frameworks. The SoP itself does not stipulate the decision outcome; it provides the factual yardstick used by the relevant statutory decision process.

• Administrative burden on decision‑makers: The technical thresholds and external methodologies (e.g. radiation dose reconstruction per ARPANSA guide in Schedule 1) require administrative capacity in the agencies that process claims to obtain and evaluate relevant expert evidence, compute exposure metrics (ppm‑years, cumulative hours, BMI histories), and reconcile pathological and microbiological findings with SoP subtype‑specific conditions. Administrative resourcing for these tasks is therefore an enforcement cost borne by the decision‑making apparatus.

• Evidential consequences for providers: Medical practitioners, laboratories and occupational hygienists who provide evidence will be required to provide documentation and calculations in formats consistent with the SoP (for example, demonstrating continuous drug exposure of at least three months and, where relevant, time since cessation; occupational exposure calculations for benzene/ethylene oxide; BMI histories to show five years of obesity within the 20 years before onset).

There is no specification in the SoP about investigatory powers, sanctions for false evidence, or penalties for non‑compliance with documentary requests. Those matters remain governed by the broader statutory and administrative framework under the VEA/MRCA and general administrative law, not by the SoP text. The instrument’s endnotes show amendment history and registration details but do not record litigation or enforcement actions connected to the instrument (Endnotes 3-4).

In short, enforcement is not penal but administrative: the SoP’s role is to trigger or not trigger a “reasonable hypothesis” for entitlement assessment, and the practical enforcement costs are those of evidentiary gathering, expert assessment and administrative decision‑making.

The SoP sits within a statutory ecosystem and explicitly cross‑references other legislative instruments and technical guides.

Statutory context and authorising provision

• Authorisation: The SoP is made under subsection 196B(2) of the Veterans' Entitlements Act 1986 (s 3). That is the statutory power by which the Repatriation Medical Authority determines Statements of Principles.

• Application to claim pathways: The instrument expressly applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (s 5). These cross‑references mean the SoP is intended to be applied by decision‑makers implementing those claim provisions. The SoP does not alter the substantive law of entitlement under those Acts; instead it supplies the RMA’s medical‑scientific determination about causal factors and reasonable hypothesis thresholds.

Cross‑references to other Statements of Principles

• Section 11 provides that if a factor in s 9 refers to an injury or disease that itself is covered by another SoP determined under s 196B(2) VEA, the factors in that other SoP apply in accordance with their terms. This creates an interactional rule: where factors are composite or referential to other diseases/injuries, the other instrument’s factors are imported as applicable law. Practically, this can chain assessments across multiple SoPs and requires decision‑makers to consult the current versions of any other relevant SoPs.

References to other statutory schedules and definitions

• The Dictionary ties “being on land in Vietnam; or at sea in Vietnamese waters” to specific items (Items 3A, 3B, 4 and 8) of Schedule 2 of the VEA (Schedule 1). That cross‑reference integrates Service‑location evidentiary rules from the VEA into this SoP. Recent amendment history shows a 2024 amendment to the Vietnam‑related definition (Endnote 3; Endnote 4).

Interaction with technical and scientific guides

• Radiation dose reconstruction: The Dictionary defines “cumulative equivalent dose” with reference to the “Guide to calculation of 'cumulative equivalent dose' for the purpose of applying ionising radiation factors contained in Statements of Principles determined under Part XIA of the Veterans' Entitlements Act 1986 (Cth), Australian Radiation Protection and Nuclear Safety Agency, as in force on 2 August 2017.” This imports an external methodology (an ARPANSA guide) for calculating radiation doses. Decision‑makers and experts must therefore apply that guide when assessing whether the 0.1 sievert threshold to bone marrow is met (s 9(24)).

• Exposure measurement conventions: The Dictionary defines “8‑hour time‑weighted average” and “ppm‑years” for benzene exposure assessments (Schedule 1). These definitions ensure consistent measurement units across claims and link the SoP to occupational hygiene practice.

Overlap with other statutory domains

• Occupational health and safety records, industrial exposure monitoring, and medical records governed by general law will be material. The SoP’s benzene, ethylene oxide, phenoxy herbicide, pesticide and chemical exposure thresholds will often require consultation of employment records, monitoring data and industrial hygiene reports; those materials fall under workplace health and safety regulatory regimes, but the SoP uses them as evidence in a veterans’ entitlement context.

• Military records and deployment records: Where service location or shipboard potable water are contested, the SoP’s definitions tie into the VEA’s Schedule 2 service area descriptions and to service documentation retained by Defence. The SoP therefore interacts functionally with records regimes under Defence and the VEA.

Temporal interaction and amendments

• The SoP is expressly modifiable and has been amended (endnotes show original registration in 2018, amendment in 2021 (No. 75) and an amendment in 2024 (No. 27) concerning Vietnam factors). The s 11 cross‑application to other SoPs is to those “as in force from time to time,” meaning claim assessments can require checking the current texts of other Statements and current technical guides.

In practical terms, the SoP is an instrument that integrates RMA medical determinations with statutory definitions and external technical methodologies. Decision‑makers must align assessments under the VEA/MRCA with the SoP’s thresholds, apply any cross‑referenced SoPs, and follow the ARPANSA methodology where radiation dose reconstruction is relevant.

The compilation includes endnotes that set out the legislative history of this particular Statement of Principles. The relevant entries in the endnotes are explicit and should be relied on for dates and instrument identifiers.

• Original instrument: Statement of Principles concerning non‑Hodgkin lymphoma (Reasonable Hypothesis) (No. 90 of 2018), registration 29 October 2018 as F2018L01489, commenced 26 November 2018 (Endnote 3 table).

• Amendment No. 75 of 2021: Amendment Statement of Principles concerning non‑Hodgkin lymphoma (Reasonable Hypothesis) (No. 75 of 2021), registered 24 May 2021 F2021L00611, commenced 21 June 2021. The amendment history table in Endnote 4 shows that section 9(8) was amended by No. 75 of 2021 (Endnote 4: “Section 9(8)………….. , am No. 75 of 2021”).

• Amendment No. 27 of 2024: Amendment Statement of Principles concerning factors relating to being in Vietnam (Reasonable Hypothesis) (No. 27 of 2024), registered 28 February 2024 F2024L00224, commenced 26 March 2024. The endnotes record that Schedule 1 - Dictionary entry for the definition of “being (a) on land in Vietnam; or (b) at sea in Vietnamese waters…” was revised by rs. No. 27 of 2024 (Endnote 4).

Other editorial changes under the Legislation Act are recorded in Endnote 4: sections 2 and 4 were repealed (rep LA s 48D and rep LA s 48C respectively), which are standard compilation and formal provisions rather than substantive SoP changes. The endnotes also explain the compilation process and that uncommenced amendments are not shown; any uncommenced amendments would be available on the Federal Register of Legislation (compilation note).

Operational implications of the amendment history:

• The SoP has been updated at least twice since inception , once in 2021 and once in 2024 , each time altering substantive elements (s 9(8) in 2021 and the Vietnam definition in 2024). Claim assessments therefore require checking the version of the instrument in force at the relevant time (the compilation date here is 26 March 2024) and any subsequent amendments.

• The 2024 amendment specifically targeted the Vietnam‑related definition contained in the Dictionary; such an amendment affects the application of the s 9(18) factor (service in Vietnam for a cumulative period) and therefore alters the evidentiary requirements for Vietnam‑related claims. The compilation notes these changes and their commencement dates in the endnotes.

• The endnotes remind users that the SoP may be modified by other laws without textual amendment in the compilation and that uncommenced amendments are not reflected; therefore practitioners must consult the Register for current uncommenced or modified provisions.

In sum, the SoP is an instrument subject to periodic amendment. The endnotes provide the authoritative amendment timeline and identify the provisions changed by each amending instrument, which must be checked when advising claimants or preparing evidence.

The compiled instrument and its endnotes do not record any litigation, case law citations, or judicial interpretations of this particular Statement of Principles. The instrument itself does not refer to any court decisions, and the endnotes do not list cases. The compilation structure is a statutory instrument plus a Dictionary and administrative endnotes; it does not provide a jurisprudential record.

Practical consequences for practitioners:

• Since the SoP text does not include or point to litigation, practitioners seeking precedential or judicial guidance on how courts or tribunals have interpreted these particular factors, thresholds or the notion of “reasonable hypothesis” in this context will need to search tribunal and court databases for decisions applying this SoP or the VEA/MRCA in relation to NHL claims.

• The absence of litigation material in the instrument itself is not evidence that there is no case law; it simply reflects that the compiled instrument does not include such material. Where factual disputes arise (for example, interpretation of exposure thresholds, measurement methodologies, or the sufficiency of a relationship to relevant service), tribunals and courts will be the places where those issues are adjudicated and reasoned.

• Practitioners should be attentive to decisions of the Veterans’ Review Board, Administrative Appeals Tribunal (where applicable), Federal Court and Federal Circuit Court on similar or related SoPs and on the application of “reasonable hypothesis” in VEA/MRCA claims. Those decisions may interpret evidentiary sufficiency, the appropriate use of technical guides (such as the ARPANSA cumulative equivalent dose guide referenced in the Dictionary), and the relationship requirement in s 10(1).

In short, the compilation contains no litigation history. Advisers will need to consult external case law databases for tribunal or judicial treatment of this SoP or closely analogous SoPs to anticipate legal argument patterns.

This instrument contains multiple technical traps and precise thresholds that, if not respected, can be decisive in claim outcomes. Key “gotchas” to watch for when advising claimants or preparing files:

• Clinical onset as the anchor date: Many temporal and latency requirements are expressed with reference to “the clinical onset of non‑Hodgkin lymphoma” (see numerous paragraphs in s 9). The date that qualifies as clinical onset will determine whether minimum latency requirements, cessation‑to‑onset windows and duration thresholds are satisfied. Practitioners must obtain and rely on contemporaneous clinical records and expert opinion to identify the correct clinical onset date.

• Subtype specificity matters: Several factors apply only to particular NHL subtypes (for example, s 9(5) Richter syndrome; s 9(6) adult T‑cell leukaemia‑lymphoma; s 9(25) diffuse large B‑cell lymphoma; s 9(26) anaplastic large cell lymphoma of the breast). Misclassification of the NHL subtype in the medical record will lead to misapplication of the factor list. Advisers must verify histopathological reports and relevant immunophenotyping/genetic testing where required.

• Timing and latency thresholds: Numerous factors require that the first exposure occurred at least five years before clinical onset (for example s 9(17) phenoxy acid herbicide, s 9(19) TCDD‑contaminated agents, s 9(28) pentachlorophenol, s 9(29) chemical from the specified list). Others require cumulative exposure within defined windows (for example s 9(17) 1,000 hours within a consecutive 10 years; s 9(20) benzene cumulative total of at least 2,500 hours within a continuous period of five years). Failing to show the precise timing or to compute cumulative hours can be fatal to a claim.

• Measurement units and methodology: The instrument uses particular metrics (ppm‑years, 8‑hour time‑weighted averages, BMI formula, cumulative equivalent dose methodology per ARPANSA) that must be applied exactly as defined in the Dictionary. For example, benzene exposure may be proven by showing ambient 8‑hour TWA benzene concentration exceeding five parts per million combined with cumulative hours (Schedule 1 definition of “being exposed to benzene as specified” and s 9(20)). Experts must compute ppm‑years, and for radiation a particular ARPANSA guide must be applied (Schedule 1: cumulative equivalent dose).

• Drug exposure continuity and cessation windows: For systemic immunosuppressive drugs from the specified list, the SoP requires a continuous period of at least three months prior to clinical onset; if exposure has ceased, the clinical onset must have occurred within ten years of cessation (s 9(4) and Schedule 1 list). Similarly, hydrochlorothiazide exposure for mycosis fungoides/Sezary syndrome has a three‑month continuous exposure requirement with a ten‑year cessation‑to‑onset window (s 9(32)). Precise prescribing records and pharmacy dispensing histories are therefore necessary.

• The “inability to obtain appropriate clinical management” factor (s 9(33)) is tightly limited by s 10(2): it applies only to material contribution to or aggravation of NHL where the person’s NHL was suffered or contracted before or during (but did not arise out of) their relevant service. This is a narrow application and does not cover all service‑related failures in care.

• Vietnam service threshold: The Vietnam factor (s 9(18)) requires being on land in Vietnam, at sea in Vietnamese waters, or consuming potable water produced by evaporative distillation of estuarine Vietnamese waters for a cumulative period of at least 30 days, at least five years before clinical onset. The Dictionary links the meaning of “being on land in Vietnam; or at sea in Vietnamese waters” to specific items in Schedule 2 of the VEA. The 2024 amendment altered the Dictionary entry, so practitioners must use the current text when assessing Vietnam claims (Endnote 3 and Endnote 4).

• Cross‑application dependencies: If a factor pertains to another SoP disease, that other SoP’s factors apply (s 11). Failure to check and apply other SoPs when they are referenced can lead to incomplete evidence or misapplied standards.

• Exclusions in the definition of NHL: The SoP excludes certain haematological malignancies (myeloma, hairy cell leukaemia, Waldenström macroglobulinaemia, acute lymphoblastic leukaemia, chronic lymphocytic leukaemia/small lymphocytic lymphoma) from “non‑Hodgkin lymphoma” for this instrument (s 7(2)(c)). Confusion between these excluded conditions and NHL in pathology reporting can misdirect a claim.

• Reliance on external guides: Dose reconstruction for radiation exposure requires following the ARPANSA guide as in force on 2 August 2017 (Schedule 1). If a dose reconstruction is prepared using a different or updated methodology, a decision‑maker may reject it in favour of the specified guide unless the RMA or relevant authority permits updates. Practitioners should check whether the guide referenced in the SoP has been superseded and how that affects current assessments.

• Documentation burden: Many factors require detailed documentary proof , military service records, occupational exposure records, pharmacy/pharmaceutical dispensing records, pathology/laboratory reports, implant and surgical records, infectious disease serology at or near clinical onset. Absence of contemporaneous records can require reconstruction by expert opinion, which is inherently contestable.

Each of these points is grounded in the instrument’s text (s 7, s 9, s 10 and Schedule 1), and each materially affects evidentiary strategy and claim viability.

Compliance here means assembling a claim package and evidentiary record that satisfies the SoP’s requirements so that a decision‑maker can conclude a reasonable hypothesis is raised that non‑Hodgkin lymphoma or death from NHL is related to relevant service. The SoP’s demands are largely evidentiary and technical. Practical steps follow directly from the instrument.

1. Confirm diagnosis and subtype; establish clinical onset

   • Obtain full pathology reports, including immunohistochemistry, flow cytometry and cytogenetics as available, to confirm the NHL diagnosis and identify the subtype (the SoP distinguishes multiple subtypes; see s 7(2) and the subtype‑specific entries in s 9).
   • Get the treating clinician’s opinion about the date of clinical onset, supported by contemporaneous notes, diagnostic test dates and symptom onset documentation, because multiple factors use clinical onset as the temporal anchor (s 9 references).

2. Identify which s 9 factor(s) is (are) potentially present

   • Map the claimant’s clinical, occupational, service and medication history to the list in s 9. Note subtype‑limited factors (e.g. s 9(25) for diffuse large B‑cell lymphoma, s 9(26) for anaplastic large cell lymphoma of the breast, s 9(6) for HTLV‑1 related adult T‑cell leukaemia‑lymphoma).
   • For infection‑linked factors, assemble laboratory evidence: HIV, HTLV‑1, H. pylori, EBV, KSHV, hepatitis B and C, Campylobacter jejuni, Chlamydia psittaci, Borrelia spp., Plasmodium falciparum (s 9(1), (6)-(16)). Where the SoP requires the infection to be present “at the time of the clinical onset,” aim to obtain contemporaneous test results or reliable serology/archival laboratory records.

3. For drug and medical history factors

   • Supply medical records and prescription/dispensing history showing continuous exposure where required:
     • Solid organ, stem cell or bone marrow transplantation prior to clinical onset (s 9(2)).
     • Systemic immunosuppressive drugs from the specified list with continuous exposure for at least three months before onset; if exposure ceased, establish clinical onset within ten years of cessation (s 9(4); Dictionary specified list).
     • Hydrochlorothiazide exposure for mycosis fungoides/Sezary syndrome: continuous three months and ten‑year post‑cessation window (s 9(32)).
   • Confirm autoimmune disease diagnoses against the specified list in the Dictionary (s 9(3); Schedule 1 list).

4. For chemical, occupational and environmental exposures

   • Gather employment and occupational hygiene records, contemporaneous monitoring data, MSDS (material safety data sheets), records of work activities (spraying, decanting, maintenance), exposure logs, and witness statements describing frequency/duration of tasks.
   • Compute exposure metrics per the Dictionary:
     • Phenoxy acid herbicide exposure: cumulative 1,000 hours within a consecutive 10 years, first exposure at least five years before clinical onset (s 9(17); Schedule 1 definitions).
     • Benzene exposure: prove cutaneous contact with liquids >1% benzene, ingestion of such liquids, or inhalation where ambient 8‑hour TWA exceeds 5 ppm; cumulative total of at least 2,500 hours within a continuous five years (s 9(20); Schedule 1 “being exposed to benzene as specified” and “8‑hour time‑weighted average”).
     • Alternatively, show greater than ten ppm‑years cumulative benzene exposure (s 9(21); Dictionary ppm‑years).
     • Ethylene oxide: cumulative 2,500 hours within a consecutive 10 years (s 9(22)).
     • Lindane: inhaling/ingesting/cutaneous contact on more days than not for a cumulative period of at least six months, at least five years before onset (s 9(27)).
     • Pentachlorophenol, TCDD‑contaminated agents, and specified chemicals (diazinon, glyphosate, malathion, trichloroethylene) have 1,000‑hour thresholds and timing requirements (s 9(19), (28)-(29) and Schedule 1 definitions).
   • Where exposure metrics are not recorded contemporaneously, commission an occupational hygienist to reconstruct exposure using accepted methods and to compute ppm‑years or time‑weighted averages per the Dictionary definitions.

5. For radiation and dose reconstruction

   • Commission a radiation dose reconstruction applying the ARPANSA Guide referenced in the Dictionary for “cumulative equivalent dose” calculations (Schedule 1). The SoP requires at least 0.1 sievert cumulative equivalent dose to the bone marrow with first exposure at least five years before clinical onset (s 9(24) and Schedule 1).

6. For service‑location factors (Vietnam)

   • Obtain service records showing presence on land in Vietnam, at sea in Vietnamese waters, or consumption of potable water produced by evaporative distillation of estuarine Vietnamese waters, for a cumulative period of at least 30 days, at least five years before clinical onset (s 9(18)). The Dictionary ties the Vietnam definitions to Items 3A, 3B, 4 and 8 of Schedule 2 of the VEA. Use unit records, ship logs, muster rolls and travel documentation to verify presence and potable water usage where applicable.

7. For lifestyle and anthropometric factors

   • Obesity: assemble serial weight/height records to show BMI ≥30 for at least five years within the 20 years before clinical onset (s 9(23) and Schedule 1 BMI formula).
   • Smoking: for T‑cell lymphoma factors, document smoking history to show at least ten pack‑years (or equivalent in other tobacco products), and if smoking ceased, show clinical onset within 20 years of cessation (s 9(30); Schedule 1 pack‑years definition).

8. For implants and surgical history

   • For anaplastic large cell lymphoma of the breast, obtain operative and prosthesis records establishing presence of a breast implant at the time of clinical onset (s 9(26)).

9. For inability to obtain clinical management (s 9(33))

   • If relying on this factor, document that NHL was suffered or contracted before or during (but did not arise out of) relevant service and produce contemporaneous evidence of lack of access to appropriate clinical management, and expert evidence linking that lack of management to material contribution or aggravation of the NHL (s 10(2) restricts this factor’s application).

10. Cross‑checks and cross‑SoP issues

• Where a s 9 factor refers to another SoP disease, obtain and apply the factors from that other SoP as currently in force (s 11). For example, if a factor references a disease which the RMA has separately treated, include evidence and arguments under that separate SoP.

11. Prepare expert reports that apply SoP definitions and methodologies

• For each technical element (radiation, occupational exposure, infectious disease timing, BMI history), obtain a written expert opinion that explicitly applies the SoP’s definitions and demonstrates the thresholds are met (for example, calculating ppm‑years, applying ARPANSA methodology, showing continuity and timing of drug exposure).

12. Audit and chronology

• Prepare a clear chronology linking service periods, exposures, treatment episodes, dates of onset, and cessation dates where relevant. Because many thresholds rely on specific timing (first exposure at least five years before clinical onset, cumulative exposure within set windows), a precise chronology is essential.

13. Keep abreast of current SoP versions

• The SoP has been amended (2021, 2024 per endnotes) and cross‑references other SoPs and external guides as they stand “from time to time.” Confirm the operative SoP version and the versions of any cross‑referenced instruments or guides at the date of the claim.

14. Anticipate rebuttal and prepare responses

• Expect challenge to reconstructed exposures and to the temporal anchoring of clinical onset. Address weaknesses proactively by assembling corroborative documentary evidence (service logs, contemporaneous medical notes, occupational monitoring reports) and by obtaining robust expert opinion explaining any reconstruction methods used.

Following these practical steps, each grounded in the SoP’s textual requirements (s 5, s 7-11 and Schedule 1), will materially improve the likelihood a decision‑maker can properly assess whether a reasonable hypothesis exists connecting NHL or death from NHL to relevant service.