Statement of Principles concerning opisthorchiasis (Balance of Probabilities) (No. 22 of 2025)

The instrument builds around five main concepts: the clinical definition of the disease; the statutory standard of causation and evidentiary threshold; the enumerated causal factors; the relationship of those factors to “relevant service”; and the interplay with other Statements of Principles.

Clinical definition. For the instrument’s purposes, “opisthorchiasis” is defined as infestation of the biliary system by Opisthorchis felineus or Opisthorchis viverrini (s7(2)). The instrument explicitly notes the common names of those trematodes and lists typical symptoms such as loss of appetite, diarrhoea or a sense of abdominal pressure (s7(2) Notes). It also records that, while ICD‑10‑AM code B66.0 is ordinarily used, the legal meaning is the clinical definition provided in subsection 7(2) (s7(3)).

Standard of causation. The Repatriation Medical Authority records that, on the sound medical‑scientific evidence available, it is of the view that it is “more probable than not” that opisthorchiasis and death from opisthorchiasis can be related to relevant service (s8). That formulation establishes a balance‑of‑probabilities standard for statutory causation under this Statement. The instrument therefore functions as a statutory medical‑evidence benchmark: where one of the listed causal factors exists and is related to relevant service, a decision maker may find, on the balance of probabilities, that service connection is established.

Enumerated causal factors. Section 9 sets out the discrete factual bases that must exist. They are time‑and‑exposure specific: ingestion of skin or flesh of raw, undercooked, iced, pickled or smoked freshwater fish at least three weeks before clinical onset (s9(1)); a liver transplant from an infected donor within seven days before clinical onset (s9(2)); and inability to obtain appropriate clinical management for opisthorchiasis before clinical worsening (s9(3)). The instrument also provides geographic notes identifying where the parasite‑contaminated freshwater fish are mainly found (s9(1) Note).

Relationship to service. The instrument requires that any of the specified factors be “related to the relevant service” rendered by the person (s10(1)). It limits the third factor: inability to obtain appropriate clinical management applies only to material contribution to, or aggravation of, opisthorchiasis where the disease was suffered or contracted before or during, but did not arise out of, relevant service (s10(2)). In short, the third factor is not available where the disease first arose out of service.

Interplay with other Statements. Section 11 establishes that, if a factor in this Statement refers to an injury or disease covered by another Statement of Principles, then the factors in that other Statement apply in accordance with its terms as in force from time to time (s11). This produces a definitional and causal cross‑reference system: one Statement can invoke the factors of another, and those factors apply as governed by that other Statement’s current terms.

Definitions. The Schedule supplies key definitions used to construe the Statement, including relevant service, terminal event, MRCA and VEA (Schedule 1). “Relevant service” is defined to include particular categories of VEA service and peacetime service under the MRCA (Schedule 1). “Terminal event” is defined by example and includes proximate or ultimate causes of death such as pneumonia, respiratory failure and cardiac arrest (Schedule 1).

Primary persons affected are current and former members of the Australian Defence Force and other persons eligible under the VEA or MRCA who claim that opisthorchiasis, or death from opisthorchiasis, is connected with their relevant service. The instrument is framed to be applied in assessments of claims where sections 120B of the VEA or 339 of the MRCA apply (s5). Those statutory provisions are not reproduced in the instrument, but their mention confines the instrument’s application to the claim types contemplated by those provisions.

The Repatriation Medical Authority is both the maker of the instrument and the expert body whose medical‑scientific view underpins the Statement (s3 and s8). Administrative decision makers who assess entitlement under the VEA or MRCA will use the Statement as a legislatively prescribed medical benchmark; the instrument supplies the medical factors that can satisfy causation on the balance of probabilities, and decision makers will apply those factors when determining whether relevant service caused or materially contributed to the disease or death. The instrument therefore affects clinicians providing medico‑legal assessments because they must address the specific factors the Statement identifies, such as the timing of exposure, transplant donor infection status, and availability of appropriate clinical management (s9).

Third parties are implicated in particular factual scenarios. For example, organ donors and transplantation records are relevant where a claimant relies on the liver transplant factor in s9(2). Medical facilities and record keepers are relevant when claimants rely on s9(3) , inability to obtain appropriate clinical management , because documentation of access to, or denial of, treatment will be material to establishing that factor. The instrument’s notes about geographic distribution of infected freshwater fish (s9(1) Note) mean that service in certain overseas locations may be particularly relevant to establishing exposure.

Families and dependants seeking entitlements for death from opisthorchiasis are affected by the instrument’s inclusion of death from the disease as within its scope; death is defined to include terminal events or conditions to which opisthorchiasis contributed (s7(4) and Schedule 1 definition of “terminal event”). The instrument therefore governs how a claim for death benefits will be assessed where opisthorchiasis is alleged to have contributed to the terminal event.

Organisations advising claimants , legal practitioners, medical experts and veterans’ representatives , are affected practically because they will need to collect and present evidence that aligns to the discrete factors the Statement requires. That includes evidence of the timing of clinical onset relative to exposure, laboratory or clinical diagnosis, transplant donor infection status, and records showing availability or otherwise of appropriate clinical care before clinical worsening. The Schedule’s definition of “relevant service” also means that establishing the entitlement depends both on medical causation and on whether the claimant’s service falls within the listed categories.

Finally, the repeal of the 2016 Statement (s4) means that any decision makers or litigants who previously relied on the earlier instrument must now apply the 2025 Statement from its commencement date (s2). The instrument itself does not specify transitional arrangements; whether an individual claim is assessed under the old or new Statement will depend on the statutory framework governing the VEA and MRCA claims process and on the commencement date provided (s2 and s4).

This Statement of Principles creates no freestanding statutory duties or civil penalties within its text. Its operational effect is to function as the medical‑evidentiary benchmark that decision makers use in assessing entitlement under the VEA and MRCA. The primary rights affected are claimants’ entitlements under those Acts, as the Statement prescribes the fact patterns that will, on the balance of probabilities, connect opisthorchiasis or death from opisthorchiasis with relevant service (s8-s10).

Claimant rights. A person making a claim under section 120B of the VEA or section 339 of the MRCA has the right to have their matter assessed using the current Statement of Principles that the Repatriation Medical Authority has determined, as applicable (s5). Practically, this gives claimants an evidentiary path to establish causal connection where one of the enumerated factors exists and is related to their relevant service (s9 and s10). The Statement also expands the scope of death claims by defining “death from opisthorchiasis” to include deaths where a terminal event was contributed to by the disease (s7(4)).

Decision maker duties. Decision makers exercising powers under the VEA or MRCA will be expected to apply the Statement in assessing whether the medical facts support a finding of service connection on the balance of probabilities. The instrument itself does not prescribe administrative procedures, but by operation of the enabling statute (subsection 196B(3) of the VEA), the Statement carries legal force as the Repatriation Medical Authority’s determination on the medical factors that can satisfy causation. Decision makers therefore have a duty to consider the Statement’s content when adjudicating relevant claims.

Expert and clinical duties. Medical experts engaged to provide opinions in support of claims will need to address the precise factors set in s9 when giving evidence. For example, an expert opinion addressing causation should note whether the patient ingested the specified types of freshwater fish at least three weeks before clinical onset, whether a donor liver was infected within seven days before onset, or whether there was an inability to obtain appropriate clinical management before clinical worsening, and whether such factors related to relevant service (s9 and s10).

Interplay with other Statements. Where a factor in this Statement refers to an injury or disease that is the subject of another Statement of Principles, the factors of that other Statement apply in accordance with its terms (s11). Decision makers must therefore integrate multiple Statements where necessary, following the other Statement’s current terms. This creates a practical duty to cross‑check Statements and apply the relevant factors together, not in isolation.

Limits on application. The instrument limits the application of certain factors. For instance, s10(2) restricts the use of the inability‑to‑obtain‑care factor to situations of material contribution or aggravation where the disease was suffered or contracted before or during, but did not arise out of, relevant service. That qualification places a legal constraint on when the third factor can be invoked to establish service connection.

No criminal or civil penalties in instrument. The Statement itself does not create offences or specify penalties; it is an evidentiary determination rather than a sanctioning provision. Its role is to inform entitlement decisions under the VEA and MRCA rather than to regulate conduct by criminal or civil sanction.

The Statement of Principles does not create criminal offences, fines, administrative penalties or a bespoke enforcement regime. The instrument is a medical‑legal determination made under subsection 196B(3) of the VEA and its operative function is to inform decision makers assessing entitlement under specified provisions of the VEA and MRCA (s3 and s5). There are therefore no penalties contained within the text for non‑compliance with the Statement itself.

Enforcement in practice is indirect. The Statement operates as the authoritative medical benchmark for causation; enforcement of entitlements and refusal of claims flow from administrative decisions under the VEA and MRCA that apply the Statement. The instrument does not prescribe the procedures, appeals processes, or sanctions available under those Acts. Consequently, any remedial or enforcement pathways will be those embedded in the VEA and MRCA, not in the Statement. The Statement makes no comment on administrative review or judicial review rights, nor does it specify internal or external oversight mechanisms.

Because there are no penalties in the instrument, the relevant compliance pressure on claimants and advisers is evidentiary rather than penal. Practitioners must present evidence that aligns with the factors enumerated in s9 and the relationship to relevant service required by s10. A decision maker’s application of the Statement may result in the grant or denial of statutory benefits; such outcomes are the practical consequences that function as the instrument’s enforcement mechanism.

Records and proof. Although the Statement does not impose record‑keeping obligations, its operation means that medical records, transplant documentation, and evidence of attempts to obtain appropriate clinical management become material to claim outcomes. The absence of specified sanctions for missing records does not neutralise their evidentiary importance. Organ‑donor records are relevant under s9(2), and documentation showing availability or denial of appropriate clinical management is relevant under s9(3) and s10(2).

Interaction with other legal enforcement mechanisms. The Statement permits cross‑reference to other Statements of Principles where a factor refers to a disease covered by another Statement; those other Statements, insofar as they are incorporated, may carry their own operative effects for decision making (s11). Any obligations or consequences framed within the VEA or MRCA , for instance in relation to fraudulent claims or false statements under those Acts , remain outside this Statement and are governed by the relevant Act. The Statement’s text does not address or modify those separate enforcement provisions.

The instrument explicitly links to two principal Acts and to other Statements of Principles. It is made under subsection 196B(3) of the VEA (s3). It applies to claims to which section 120B of the VEA or section 339 of the MRCA applies (s5). The Schedule defines MRCA and VEA and sets out what “relevant service” means for the instrument’s purposes (Schedule 1). The instrument does not amend or displace the procedural or remedial provisions of those Acts; rather, it operates within their claim assessment framework by supplying the Repatriation Medical Authority’s medical determination of the factors that establish causation.

Cross‑Statement interaction. Section 11 provides a mechanism for interaction with other Statements of Principles. Where a factor in this Statement refers to an injury or disease covered by another Statement determined under subsection 196B(3) of the VEA, the factors set out in that other Statement apply according to its terms as in force from time to time (s11). This is a hierarchical, incorporative mechanism: one Statement can invoke the factors of another, and the other Statement’s current wording governs how those factors apply. Practically, a decision maker may need to apply multiple Statements in an integrated way. The instrument does not prioritise one Statement over another; it requires application in accordance with each Statement’s terms.

Reference to ICD‑10‑AM. The instrument references ICD‑10‑AM (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification) for coding purposes, but clarifies that the legal meaning of “opisthorchiasis” is the clinical description in s7(2) regardless of the ICD code (s7(3)). This means that clinical coding guides are informative but not determinative of the Statement’s legal meaning. The instrument states the edition and date of the ICD‑10‑AM version it references (Tenth Edition, effective 1 July 2017) (s7(3)).

Scope relative to VEA and MRCA. The Statement’s application is constrained to the claims within the statutory reach of the cited sections of the VEA and MRCA (s5). It does not purport to govern private tort claims, public health regulation, immigration law, or other statutory schemes outside those Acts. The definitions in the Schedule, particularly of “relevant service”, determine who falls within the instrument’s ambit and therefore who can invoke it in relation to the VEA and MRCA.

Repeal of prior Statement. The instrument repeals the earlier Statement No. 46 of 2016 (Federal Register No. F2016L00584) (s4). That repeal will displace the earlier Statement for the purposes of claim assessments under the VEA and MRCA from the commencement date of this instrument (s2). The instrument does not include transitional provisions addressing how to treat claims lodged before commencement; those matters are governed by the broader statutory and administrative framework of the Acts to which this Statement applies.

No interplay with offences or public health statutes in text. The Statement contains no provisions that directly interact with criminal law, organ transplant regulation, or public health statutes. Where such laws contain their own record‑keeping, reporting or offence provisions, they remain separate; the Statement’s reference to clinical management and transplant donor infection status (s9(2)-(3)) is evidentiary for claims purposes, not regulatory.

This Statement of Principles is identified as No. 22 of 2025 and dated 18 February 2025 (front matter). It commences on 25 March 2025 (s2). It expressly repeals the Statement of Principles concerning opisthorchiasis (No. 46 of 2016), Federal Register of Legislation No. F2016L00584 (s4). No other amendments or prior versions are recorded within the instrument.

Documents cited within the instrument include the ICD‑10‑AM Tenth Edition (effective 1 July 2017) for clinical coding reference (s7(3)). The instrument does not contain any transitional, savings or grandfathering clauses addressing claims that were in progress at the time the new Statement commences. The only immediate legislative history contained in the text is the express repeal of the 2016 Statement, meaning that, from 25 March 2025, the 2016 instrument is no longer in force and is replaced for the purposes of determinations under the VEA and MRCA.

Because the instrument is made under subsection 196B(3) of the VEA, its amendment or repeal in future would be governed by the same statutory power. The instrument itself contains no provision about how future amendments would be promulgated; ordinary statutory and administrative processes for Statements of Principles apply. The Schedule includes definitions which fix certain interpretive elements for this Statement; any amendment that affects those definitions would alter interpretation and application from the date any such amendment takes effect.

No chronological list of previous amendments to the 2016 Statement is included. The instrument does not record whether the 2016 Statement was itself amended prior to repeal. Users seeking amendment history beyond the explicit repeal and the new instrument’s commencement date must consult archives of past Statements, the Federal Register entry referenced for the 2016 instrument, and any administrative records kept by the Repatriation Medical Authority or the Department responsible for the VEA and MRCA. The Statement does not itself identify consultation processes or the medical evidence base in detail; it records only the Repatriation Medical Authority’s conclusion that, on the sound medical‑scientific evidence available, a more‑probable‑than‑not link between opisthorchiasis and relevant service exists (s8).

The instrument contains no account of any litigation that has tested the Statement or its predecessors. It repeals the 2016 Statement (s4) but does not list any cases or judicial review outcomes concerning either the 2016 instrument or earlier decisions that applied it. The body of the instrument is limited to the medical determination, the definitions and the factors; there is no annotated judicial history included.

Practitioners seeking litigation history must therefore consult external legal databases and court records, because the instrument itself does not provide that information. The lack of litigation material in the instrument means that the Statement stands as an administrative medical determination and any challenge to it or to a decision applying it would be pursued under the administrative law pathways and statutory appeal mechanisms that govern VEA and MRCA decisions. The instrument does not outline those pathways; it only identifies the statutory sections under which it applies (s3 and s5).

Because the Schedule defines “relevant service” and “terminal event”, those definitions will be focal points in any dispute about whether a claimant’s service qualifies or whether death falls within the instrument’s definition of death from opisthorchiasis (Schedule 1). Disputes about factual application of s9 factors , for example, timing of ingestion relative to clinical onset, donor infection status, or inability to obtain clinical management , will similarly be matters for evidentiary contest in any administrative appeal or court review. The instrument itself does not describe prior case outcomes or appellate interpretations.

In short, this instrument supplies the medical yardstick for causation but records no litigation history. Any analysis of how courts have interpreted similar Statements, how they treat the Repatriation Medical Authority’s conclusions, or whether particular factual scenarios have been litigated, must be undertaken from primary legal sources outside the text of this Statement.

This instrument contains several technical points that are easy to miss but are material to claim outcomes. Practitioners should note each of these, and rely on the text when advising clients.

Narrow, time‑specific exposure windows. The ingestion factor requires that the claimant ingested the skin or flesh of raw, undercooked, iced, pickled or smoked freshwater fish at least three weeks before clinical onset (s9(1)). The instrument is precise about the types of fish preparation and the minimum interval to clinical onset. Evidence that falls short of that three‑week threshold or that indicates cooked or marine fish rather than freshwater fish will not satisfy the specified factor under this Statement.

Geographic note is informative but not determinative. The Statement’s Note explains that freshwater fish contaminated by O. viverrini are mainly found in Southeast Asia and those contaminated by O. felineus are mainly found in Eastern and Central Europe and Southeast Asia (s9(1) Note). That geographic note is informational; the legal test remains whether the ingestion factor and relation to relevant service are established. Service in a region where contaminated fish are unlikely will weaken claims reliant on the ingestion factor, but the instrument does not convert the note into an explicit geographic limitation beyond the text.

Liver transplant timing is tight. The transplant factor applies where the claimant had a liver transplant and the donor liver was derived from a person infected with one of the relevant parasites, where that transplant occurred within the seven days before clinical onset (s9(2)). The seven‑day window is short. Evidence must therefore support both donor infection status and the timing of clinical onset relative to transplant. Absence of donor infection records, ambiguous donor testing, or later onset will undermine reliance on this factor.

Third factor is conditional and limited. The inability to obtain appropriate clinical management factor is limited by s10(2): it applies only to material contribution to, or aggravation of, opisthorchiasis where the disease was suffered or contracted before or during, but did not arise out of, relevant service. In practice, this means that the third factor cannot be used where the disease first arose out of service. Practitioners should not assume that evidence of treatment unavailability during service will, by itself, establish service connection unless the disease was suffered before or during that service and did not arise out of it.

Definition of death includes terminal event contribution. Death from opisthorchiasis includes death from a terminal event or condition that was contributed to by the person’s opisthorchiasis (s7(4)). The Schedule defines “terminal event” broadly by example and includes proximate or ultimate causes such as pneumonia, respiratory failure and cardiac arrest (Schedule 1). However, the legal standard remains contribution. Evidence must tie the opisthorchiasis to the terminal event as a contributing factor.

ICD‑10‑AM code is not determinative. Although the Statement notes that opisthorchiasis attracts ICD‑10‑AM code B66.0 (s7(3)), it also states that the meaning of opisthorchiasis for this Statement is the clinical definition in subsection 7(2). Practitioners must therefore ensure clinical evidence addresses the elements of the clinical definition, not merely the coding.

No transitional provisions. The instrument repeals the 2016 Statement (s4) and commences on a specified date (s2) but contains no transitional rules. Where a claim straddles the commencement date, practitioners should examine the underlying VEA and MRCA provisions and administrative guidance to determine which Statement applies; the instrument itself does not resolve transitional application.

Cross‑Statement dependencies. If a factor in this Statement refers to an injury or disease covered by another Statement, the other Statement’s factors apply as in force from time to time (s11). This can complicate claim preparation because practitioners must identify and apply the current terms of any referenced Statement. Failure to identify an applicable other Statement will risk missing relevant factors.

Burden of proof remains on balance of probabilities. The instrument characterises the RMA’s view as being that it is “more probable than not” that opisthorchiasis can be related to relevant service (s8). Practitioners should therefore frame evidence to meet the balance‑of‑probabilities threshold with respect to both the existence of an enumerated factor and its relation to relevant service.

Record proof matters. For the transplant and treatment access factors, documentary records are likely to be decisive. Lack of donor infection status, incomplete transplant documentation, or absence of contemporaneous clinical records evidencing attempts to obtain care will hinder reliance on the relevant factors. The instrument does not relieve claimants of evidentiary burdens; it sets out the types of facts that, if proven, will satisfy causation.

Advising claimants and preparing evidence for decisions under this Statement requires alignment with its precise factual triggers and definitions. The instrument does not create procedural duties but prescribes the factual thresholds decision makers will use to find causation on the balance of probabilities. The following is a source‑grounded checklist and practical evidence strategy based on the instrument’s text.

Establish clinical diagnosis and onset. Obtain contemporaneous medical records that document diagnosis of opisthorchiasis, clinical signs and symptoms (for example, loss of appetite, diarrhoea, abdominal pressure as noted in s7(2) Notes), and the date of clinical onset. The Statement defines “opisthorchiasis” clinically (s7(2)); coded diagnoses alone (ICD‑10‑AM B66.0) are supportive but the legal meaning is the clinical definition (s7(3)). Ensure records show the date of clinical onset, because timing is central to s9 factors.

For ingestion claims (s9(1)). Assemble evidence that the claimant ingested the skin or flesh of raw, undercooked, iced, pickled or smoked freshwater fish at least three weeks before clinical onset. Evidence may include service records showing location and food supply, witness statements, contemporaneous diaries or reports, medical histories taken at the time of presentation, or unit logs that document meals or local food practices. Because the instrument’s examples identify freshwater fish contaminated with O. viverrini in Southeast Asia and O. felineus in Eastern and Central Europe and Southeast Asia (s9(1) Note), place of exposure can strengthen or weaken the claim; ensure location and date evidence is precise.

For transplant claims (s9(2)). Obtain transplant surgery records, donor records and laboratory testing that show the donor liver came from a person infected with Opisthorchis viverrini or Opisthorchis felineus. Crucially, demonstrate that the transplant occurred within seven days before clinical onset. Documentation should support both donor infection status and precise timing of transplant and subsequent clinical onset. Absent donor infection documentation, a transplant factor claim will be vulnerable.

For inability to obtain appropriate clinical management (s9(3) and s10(2)). Where reliance is placed on this factor, assemble contemporaneous records showing attempts to obtain diagnosis or treatment, refusals, lack of services, or other barriers to appropriate clinical management prior to clinical worsening. Remember s10(2)’s limitation: this factor is only available where the person’s opisthorchiasis was suffered or contracted before or during (but did not arise out of) relevant service. Therefore provide evidence of the timing of disease relative to service. Documentation may include medical referrals, hospital admission records, clinic logs, correspondence about unavailable medications or procedures, and witness evidence from medical staff.

Establish relation to relevant service (s10(1)). For any of the factors, the claimant must show that the factor is related to relevant service. Collect service records that establish the period and nature of service, locations of deployment or postings, and the circumstances that give rise to exposure or treatment limitations. The Schedule’s definition of “relevant service” identifies particular categories of VEA and MRCA service (Schedule 1). Ensure counsel or advisers map the claimant’s service into those defined categories and demonstrate how the factor is causally linked to that service.

Address death claims with terminal event evidence (s7(4) and Schedule 1). For death claims, obtain the death certificate, autopsy or coroner reports, and treating clinician opinions that explain how opisthorchiasis contributed to the terminal event. The Schedule’s definition of “terminal event” includes examples such as pneumonia and respiratory failure; medical opinions should explain the causal pathway from opisthorchiasis to the terminal event and death.

Cross‑reference other Statements (s11). If a factor refers to an injury or disease covered by another Statement of Principles, identify that other Statement and incorporate its required evidence. Practically, this will mean checking the current text of any referenced Statement, because s11 instructs that those other Statement factors apply as in force from time to time.

Prepare medico‑legal opinions to the required standard. Experts should frame opinions to the balance of probabilities standard the instrument contemplates (s8). Opinions should explicitly address whether the enumerated factor(s) exist, the timing of exposure relative to clinical onset, and how those factors relate to relevant service. For the transplant and inability‑to‑obtain‑care factors, an expert should explain the clinical plausibility that those factors materially contributed to or aggravated the condition.

Document chain of evidence and provenance. For ingestion or transplant claims, corroborate testimonial evidence with documentary material wherever possible. For overseas exposures, include country and region information, dates and any contemporaneous evidence of local endemicity consistent with the instrument’s geographic notes (s9(1) Note). For inability to obtain appropriate clinical management claims, contemporaneous administrative or medical correspondence is particularly probative.

Consider sequencing and timing. The instrument’s factors hinge on short windows (three weeks and seven days). Carefully sequence clinical onset, exposure events and any transplant dates in a timeline. Inconsistent or vague timing will be detrimental.

Be alert to definitions in the Schedule. Ensure advisers and experts use the instrument’s definitions of “relevant service” and “terminal event” when preparing submissions. Failure to align the legal characterisation of service or death with the Schedule definitions may lead to misapplication of the Statement.

Record retention and retrieval. Because the Statement relies heavily on clinical and service records, ensure claimants authorise retrieval of medical and service records early. For transplant evidence, obtain donor and surgical records. For treatment access claims, seek contemporaneous notes, referral and triage records, and correspondence.

No special form or additional process appended. The instrument does not prescribe particular forms or extra procedural steps beyond the usual claim processes under the VEA and MRCA. Compliance therefore means preparing claims that present evidence aligned to the Statement’s factors and definitions and submitting them within whatever procedural framework the VEA and MRCA impose.

In short, compliance is primarily evidentiary. Practitioners should assemble timelines, contemporaneous medical and service documentation, transplantation records where relevant, and robust medico‑legal opinions that address the precise factors and their relation to relevant service as set out in ss7-11 and the Schedule.