Statement of Principles concerning optochiasmatic arachnoiditis (Balance of Probabilities) (No. 96 of 2025)

The instrument rests on a small set of linked concepts that govern its application: the clinical entity (optochiasmatic arachnoiditis), the evidentiary standard, the list of qualifying factors, the timing relationship with relevant service, and cross-reference to other SoPs and external dose‑calculation methodology.

Definition of the clinical entity. Optochiasmatic arachnoiditis is defined clearly and narrowly as chronic inflammation of the arachnoid membrane surrounding the optic chiasm and intracranial optic nerves, producing fibrosis and adhesions and typically presenting with progressive visual loss (s7(2)). Death from OA is included where death was from a terminal event or condition that was contributed to by the person’s OA; "terminal event" is defined in the Schedule and includes examples such as pneumonia and respiratory failure (s7(3); Schedule, terminal event).

Evidentiary standard. The SoP is expressly determined on the balance of probabilities standard, as indicated by the instrument title and by the Repatriation Medical Authority’s statement that it is "of the view that it is more probable than not" that OA and death from OA can be related to relevant service (s8). The SoP therefore prescribes the medical-scientific factors that, if established, will meet the causation test used in statutory claims processes.

List of qualifying factors. Section 9 sets out eight discrete factors, any one of which must exist before OA or death from OA can be said to be connected with relevant service on the balance of probabilities (s9). These factors are concrete clinical or exposure events: prior tuberculous leptomeningeal infection; treatment with antibiotics for tuberculous meningitis at least 30 days before onset/worsening; subarachnoid haemorrhage; retained muslin or cotton packing after surgery involving or adjacent to the optic chiasm left in situ for at least 30 days; a cumulative equivalent ionising radiation dose of at least 60 sieverts to the optic chiasm region; intrathecal myelogram or intrathecal iophendylate (Pantopaque or Myodil); and inability to obtain appropriate clinical management before clinical worsening (s9(1)-(8)).

Timing and relationship to service. The instrument requires that any such factor must be related to the person’s relevant service (s10(1)). The "clinical worsening" limb of the factors is limited: it applies only where OA was suffered or contracted before or during (but did not arise out of) relevant service, and then the factor must materially contribute to or aggravate OA (s10(2)). This establishes a temporal and causal limitation on reliance on the "worsening" formulation.

Interaction with other Statements of Principles. Section 11 provides that if a factor in this SoP refers to an injury or disease that is the subject of another SoP determined under s196B(3) of the VEA, then the factors in that other SoP apply according to its terms. This creates an explicit mechanism for cross‑application where the listed factor is itself governed by a separate SoP (s11).

Dose calculation methodology. The Schedule defines "cumulative equivalent dose" and requires use of the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) guide "as in force on 2 August 2017" to calculate dose for ionising radiation factors; the definition excludes normal background radiation in Australia (Schedule, cumulative equivalent dose). This ties radiation‑exposure factors to an external technical methodology.

Together these concepts define a tightly focused causation instrument centred on named antecedent clinical events and exposures, with specific timing requirements and a prescribed evidentiary standard (s7-s11; Schedule).

Primary affected persons. The SoP applies to claimants making applications under section 120B of the VEA or section 339 of the MRCA (s5). That means veterans and members of the Forces whose claims invoke the statutory pathways specified will be directly affected insofar as causation of optochiasmatic arachnoiditis or death from OA is at issue. The instrument governs the medical causation criteria that decision-makers must apply to those claims (s5, s8).

Medical and clinical professionals. Treating clinicians, neurosurgeons, ophthalmologists, radiologists, infectious disease specialists and other medical experts who provide evidence for claims will be affected because the SoP sets out the specific clinical events and exposures that will support causation. In particular, clinicians will be asked to document prior tuberculous leptomeningeal infection, antibiotic treatment for tuberculous meningitis and its timing, occurrence of subarachnoid haemorrhage, details of neurosurgical procedures and retained packing materials, intrathecal myelography with iophendylate, radiation exposure records and evidence addressing whether appropriate clinical management was available (s9(1)-(8)).

Claims assessors and administrative decision-makers. The SoP will be used by claims assessors within the Department of Veterans’ Affairs and any other decision-makers applying the VEA or the MRCA to determine whether OA or a death contributed to by OA is connected with relevant service (s5, s8). The instrument does not itself name the decision-makers, but it is framed as an authoritative statement of the medical factors decision-makers must use.

Families and dependants in death claims. Where death from OA is pleaded, the SoP’s definition of death from OA includes death from a terminal event contributed to by OA and defines "terminal event" with examples in the Schedule; this will affect entitlements that depend on causation of death (s7(3); Schedule, terminal event).

Record-keepers and service record custodians. The SoP requires establishing that a factor was related to relevant service (s10(1)). Establishing that relationship will typically require access to service records, surgical records, hospital charts, radiotherapy dosimetry and operational records documenting exposures. Entities that hold those records will therefore be involved in the evidence chain.

Other SoP regimes. Because section 11 imports factors from other SoPs where relevant, persons affected by OA claims may also need to interact with the procedures and evidentiary requirements of those other statements if one of the factors refers to an injury or disease covered elsewhere (s11).

What the instrument does not directly do. The SoP does not itself confer or pay benefits, nor does it set administrative procedures, timelines or penalties. It is a medical standard document intended to be applied within statutory claims processes (s3, s5). It also does not prescribe clinical standards of care beyond listing "inability to obtain appropriate clinical management" as a potential factor (s9(8)), and it does not define what constitutes "clinical worsening" within the instrument.

In short, the principal actors affected are claimants (veterans and members), their medical advisers and evidence providers, the administrative decision-makers applying the VEA and MRCA, and the custodians of clinical and service records necessary to demonstrate the listed factors and their relationship to relevant service (s5, s9, s10).

This instrument largely establishes evidentiary criteria rather than imposing obligations or conferring new statutory rights. Its legal effect is to set the medical causation principles that must be used in claims processes under the VEA and MRCA (s3, s5, s8). The practical duties and rights that flow from the SoP are therefore mostly procedural and evidentiary within the claims context.

Duty of decision-makers to apply the SoP. The SoP is a determination by the Repatriation Medical Authority under subsection 196B(3) of the VEA (s3). Where a claim falls within section 120B of the VEA or section 339 of the MRCA, the instrument applies (s5). Decision-makers determining whether OA or death from OA is connected with service must use the factors in the SoP as the medical-scientific basis for that determination (s8, s9). The instrument thus imposes a duty on statutory decision-makers in claims processes to consider the listed factors and the definitions in the Schedule.

Right of claimants to have causation tested against the SoP. Claimants have the right to have their claim assessed against the criteria: at least one of the factors in section 9 must exist and must be related to relevant service before causation can be accepted on the balance of probabilities (s9, s10(1)). The title and text show the standard of proof is the balance of probabilities (s8), so claimants can rely on the SoP where they can marshal evidence satisfying those factors.

Duty to demonstrate relationship to relevant service. The instrument requires that any factor alleged under section 9 "must be related to the relevant service rendered by the person" (s10(1)). That means claimants bear the task of establishing a causal or temporal link between the qualifying factor and the person’s relevant service as defined in the Schedule,eligible war service, defence service (other than hazardous service and British nuclear test defence service) under the VEA, or peacetime service under the MRCA (Schedule, relevant service). The SoP does not itself specify evidentiary burdens or procedures, but the requirement is explicit.

Limitations on the "clinical worsening" path. Section 10(2) narrows a claimant’s ability to rely on the "clinical worsening" aspect of factors in section 9. It applies only where OA was suffered or contracted before or during (but did not arise out of) relevant service; the factor must materially contribute to or aggravate OA. This creates an evidential and substantive threshold for claims based on aggravation rather than initial causation.

Duty to apply external technical methodology for radiation factors. Where ionising radiation exposure is invoked, the SoP requires calculation of "cumulative equivalent dose" as defined in the Schedule and calculated in accordance with the ARPANSA guide "as in force on 2 August 2017" (Schedule, cumulative equivalent dose). Decision-makers and experts will therefore have to apply that external methodology when radiation is the claimed factor.

Rights not created by the SoP. The instrument does not itself create entitlement to compensation, procedural appeal rights, or payment mechanisms. Those rights are governed by the VEA and MRCA statutory schemes. The SoP functions as a medical input into those schemes rather than as an independent source of entitlement.

Ambiguities and interpretative duties. The SoP uses terms that are not exhaustively defined in the instrument, such as "clinical worsening" and "appropriate clinical management." The absence of precise definitions imports interpretative duties to decision-makers and experts to apply ordinary clinical and legal standards when assessing these items (s9(8); s10(2); Schedule). Section 11 further requires application of other SoPs where factors refer to injuries or diseases covered elsewhere, so decision-makers must cross-check consistency with other determinations.

In summary, the principal duties established by the instrument are for decision-makers to use the listed medical factors and Schedule definitions when assessing causation under the VEA and MRCA. Claimants' principal right is to have their causation assessed under the balance of probabilities against those factors, with the obligation to establish a factor and its relation to relevant service (s5, s8, s9, s10, Schedule).

The Statement of Principles is a medical determination instrument and does not itself create criminal or civil penalties, enforcement mechanisms, administrative sanctions, or direct payment instruments. The text contains no provisions imposing fines, imprisonment, or administrative penalties. It operates as an evidentiary and causation standard to be applied in statutory decision-making under the VEA and MRCA (s3, s5, s8). The instrument’s enforcement is therefore indirect: it becomes operational through its application by decision-makers handling claims under the VEA and MRCA.

Administrative enforcement via claims processes. The practical "enforcement" of the SoP occurs when administrative decision-makers accept or reject claims based on whether a claimant can establish that at least one of the factors in section 9 existed and was related to relevant service (s9, s10(1)). Acceptance under those processes may lead to entitlements or benefits under the VEA or MRCA; rejection will deny those pathways. However, the SoP itself does not set the consequences of acceptance or rejection; those consequences are determined by the substantive statutory regimes (s5, s8).

No penalty provisions in the instrument. The instrument contains no provisions for sanctioning parties who provide false evidence, nor does it describe procedures for enforcement of any clinical duties. Claims processes under the VEA and MRCA include their own administrative and legal frameworks which may address adverse conduct; those frameworks lie outside the text of this SoP (s3, s5).

Role of cross-referenced SoPs and external guides. Section 11 requires that where a factor refers to an injury or disease governed by another SoP, the factors in that other SoP apply. The SoP therefore imports the application rules of other determinations but does not itself create enforcement measures. The Schedule requires use of an ARPANSA guide for radiation dose calculation. Compliance with that technical methodology is necessary to trigger the radiation-related factor; failure to apply the specified guide properly would undermine a claimant’s evidentiary basis but is not itself penalised by this instrument (Schedule, cumulative equivalent dose).

Relevance for decision review or litigation. Because the SoP frames the medical causation criteria used by decision-makers, it will be central to any administrative review or judicial appeal where causation of OA is disputed. The SoP does not itself prescribe review rights or appeal processes; those are in the VEA and MRCA statutory schemes. The instrument contains no litigation provisions or noted cases (the text does not reference litigation history) so any enforcement through review or litigation will proceed under the broader statutory framework rather than under penalties the SoP creates.

Commencement and repeal as operational enforcement points. The instrument’s commencement date (24 November 2025) and repeal of the 2016 SoP (s2, s4) mean that claims lodged or assessed after commencement will be subject to this determinate SoP rather than the repealed instrument. That timing directly affects administrative application, but again the instrument does not itself create penalties for non-compliance with its terms beyond their effect on claim outcomes.

In sum, the SoP imposes no penalties; its enforcement is functional,its criteria determine whether causation is established for the purposes of statutory claims, and the administrative and legal consequences flow from the VEA and MRCA regimes rather than from the SoP itself (s3, s5, s8, s9, Schedule).

This SoP is explicitly tied to the legal regimes under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. It is made under subsection 196B(3) of the VEA (s3) and applies to claims to which section 120B of the VEA or section 339 of the MRCA applies (s5). These statutory cross-references define the instrument’s legal field and indicate how it will be used within broader adjudicative processes.

Application within VEA and MRCA decision-making. The instrument is a determination intended for use in the VEA and MRCA claims processes (s3, s5). It sets the causation criteria decision-makers must apply when assessing whether OA or death from OA is connected with relevant service. The SoP therefore interfaces directly with the statutory tests, evidentiary regimes, procedural rights, and benefit entitlements that the VEA and MRCA provide. The SoP does not itself alter substantive entitlements under the parent statutes; instead it supplies medical causation content that the statutes require be considered.

Cross-reference to other Statements of Principles. Section 11 creates a formal interaction with other SoPs made under subsection 196B(3) of the VEA. If a factor in this SoP refers to an injury or disease covered by another SoP, then the factors in that other SoP "apply in accordance with the terms of that Statement of Principles as in force from time to time" (s11). This mechanism ensures consistency across SoPs where a listed factor is itself a condition governed by a separate SoP. The practical effect is that decision-makers must locate and apply the contemporaneous text of any other relevant SoP and reconcile its factors with those of this SoP.

Interaction with technical guidance from ARPANSA. The Schedule defines "cumulative equivalent dose" and requires calculation according to the ARPANSA guide "as in force on 2 August 2017" (Schedule, cumulative equivalent dose). This imports an external technical methodology into the statutory causation framework. In practice, radiation-dose reconstructions for a claimant will need to follow that guide to satisfy the radiation-related factor in section 9(5). The SoP therefore creates a regulatory intersection between veterans’ entitlements decision-making and externally maintained radiological methodology.

Overlap with service definitions. The Schedule defines "relevant service" for the purposes of the SoP as eligible war service and defence service under the VEA (with specified exclusions) and peacetime service under the MRCA (Schedule, relevant service). That ties the SoP to the statutory definitions of service exposure in the VEA and MRCA. Decision-makers must therefore apply the SoP only to persons whose service falls within those definitions.

No divergence from statutory procedures. The SoP does not purport to override or alter procedural or remedial provisions of the VEA or MRCA. It is a medical determination to be applied within the existing statutory framework. It does not, for example, set appeal mechanisms, time limits, or compensation scales; those remain governed by the primary statutes.

Temporal replacement of prior SoP. The instrument repeals the earlier Statement of Principles concerning optochiasmatic arachnoiditis (No. 58 of 2016) (s4). Where claims span the repeal and replacement dates, decision-makers will need to determine which SoP applies in accordance with the parent statutes’ transitional rules, if any. The instrument itself does not state transitional arrangements; it only provides the commencement date (24 November 2025) (s2) and the fact of repeal (s4).

Limits to statutory reach. The SoP addresses only the medical causation question for OA and death from OA. Issues of entitlement, procedural fairness, review rights, detection of fraudulent claims, or administrative sanctions are outside the SoP’s text and are to be dealt with under the VEA and MRCA. The instrument therefore interacts with those statutes as a specialised medical input rather than as a general amendment to veterans’ law.

In short, the instrument is designed to be applied inside the VEA/MRCA decision framework, to interoperate with other SoPs where factors overlap, and to rely on an external ARPANSA methodology where radiation exposure is alleged (s3, s5, s8, s11, Schedule).

The instrument contains limited explicit amendment history in its own text. It records that it repeals the earlier Statement of Principles concerning optochiasmatic arachnoiditis (Balance of Probabilities) (No. 58 of 2016), Federal Register of Legislation No. F2016L00568, which had been made under subsections 196B(3) and (8) of the VEA (s4). The current instrument is made under subsection 196B(3) only (s3). The instrument’s date is shown as 24 October 2025 and its commencement is 24 November 2025 (front matter and s2).

What the instrument records. The explicit historical points contained in the text are (1) the existence of the prior 2016 SoP addressing the same condition, (2) that the 2016 instrument was determined under subsections 196B(3) and (8), and (3) that the 2016 SoP is repealed by this instrument (s4). The present instrument’s formal making date of 24 October 2025 and chairperson signature are recorded (front matter), and the commencement date is specified (s2).

No other amendments recorded. The text contains no schedule of previous amendments, notations of interim variations, or side‑by‑side comparison with the repealed instrument. It does not record why the prior SoP was repealed nor what textual or conceptual changes were made relative to the 2016 instrument. The instrument does not attach an explanatory memorandum or amendment history within the text provided.

Implication for historical claims. Because the instrument repeals an earlier SoP, decision-makers and claimants will need to consider which SoP applies to claims at particular points in time. The instrument specifies its own commencement date (s2) and repeal of the earlier instrument (s4) but does not provide transitional provisions in its text. Applicability across time may therefore be governed by the parent statutes and administrative practice rather than by express transitional clauses in this instrument.

External reference point for radiation methodology. The Schedule imports an ARPANSA guide "as in force on 2 August 2017" for calculating cumulative equivalent dose (Schedule, cumulative equivalent dose). This historical fixation indicates that the SoP utilises a dated version of that technical guidance. The instrument does not record any subsequent amendments to that methodology or indicate whether future updates would be incorporated automatically; it specifies the guide "as in force on 2 August 2017."

Summary. The amendment history recorded in the instrument is limited: it replaces the 2016 SoP (No. 58 of 2016) and commences on 24 November 2025 (s2, s4). The instrument itself does not catalogue other changes or provide a comparative or explanatory history within its text.

The instrument’s text contains no references to litigation, judicial decisions, or prior adjudication relating to optochiasmatic arachnoiditis or to the application of the earlier or present Statements of Principles. It does not name any cases, nor does it summarise any judicial interpretations of the SoP or of the causal factors it lists.

Consequently, there is no litigation history recorded within this instrument that informs how courts or tribunals have interpreted any aspect of this SoP. The absence of cases in the text does not mean there has been no litigation in practice, but the instrument itself provides no record of precedent, contested points, or judicial clarifications.

Implication for decision-makers and claimants. Because the SoP contains no recorded litigation history, administrative decision-makers and legal representatives assessing claims must rely on the text of the SoP, the Schedule definitions, and the parent statutes for guidance. Where questions of interpretation arise,such as the meaning of "clinical worsening", "appropriate clinical management", or how to apply the ARPANSA guide,those matters would be resolved by the usual administrative and judicial review channels under the VEA and MRCA. The instrument does not provide interpretive doctrine or precedent within its text (s9(8), s10(2), Schedule).

Relationship to cross-referenced SoPs. Section 11 directs that, where a factor in section 9 refers to an injury or disease covered by another SoP, the factors in that other SoP apply in accordance with its terms (s11). Any litigation history relevant to those other SoPs would therefore be relevant to interpreting the factor insofar as it points to another injury or disease. However, the present instrument contains no such litigation history or citations within its text.

Concluding note. The instrument itself records no litigation history. Practitioners should therefore plan to use administrative review or judicial avenues under the VEA and MRCA to resolve contested interpretations, and to check external databases and legal sources for any case law that may have arisen concerning the previous 2016 SoP or the present instrument, because the instrument provides no such record internally.

This SoP is short and technically specific, but there are multiple points where its precise wording creates traps or interpretive risks for claimants, medical experts and decision-makers. The following are concrete points, grounded in the instrument’s text, that commonly produce disputed outcomes if not attended to.

At least one factor must be present and linked to relevant service. The SoP requires "at least one of the following factors" in section 9 (s9) and that the existence of any such factor "must be related to the relevant service rendered by the person" (s10(1)). A claimant cannot rely on generalised association between service and OA; they must identify and prove a particular listed antecedent or exposure and connect it to the defined relevant service (Schedule, relevant service).

Timing thresholds are specific. Several factors require a minimum period between exposure or treatment and clinical onset or worsening. For example, antibiotic treatment for tuberculous meningitis must have been "at least 30 days before clinical onset or clinical worsening" (s9(2)); retained muslin or cotton must have been left in situ "at least 30 days before clinical onset or clinical worsening" (s9(4)). These temporal thresholds are mandatory in the text and will be determinative if records show shorter intervals.

"Clinical worsening" is restricted and not defined. Section 10(2) restricts the clinical worsening limb to cases where OA was "suffered or contracted before or during (but did not arise out of) the person's relevant service" and where the factor materially contributed to or aggravated OA. The instrument however does not define "clinical worsening" or set a metric for "material contribution" or "aggravation." That lack of definition creates interpretative work for practitioners and decision-makers and raises evidentiary questions about onset dates, baseline severity and measurement of aggravation (s10(2)).

Radiation threshold is explicit and technically demanding. Section 9(5) requires a "cumulative equivalent dose of at least 60 sieverts" to the region of the optic chiasm before clinical onset or worsening. The Schedule then requires calculation "in accordance with the methodology set out in" an ARPANSA guide as in force on 2 August 2017 (Schedule, cumulative equivalent dose). Two gotchas arise: first, 60 sieverts is a specific threshold that must be proven by dose reconstruction; second, the required methodology is an external technical guide frozen to its 2 August 2017 version. Practitioners must ensure that dose reconstructions strictly follow that guide and document the exclusion of normal background radiation exposures (Schedule).

"Ability to obtain appropriate clinical management" is a factor but undefined. Section 9(8) lists "inability to obtain appropriate clinical management for optochiasmatic arachnoiditis before clinical worsening" as a qualifying factor. The SoP does not define what constitutes "appropriate clinical management," nor does it state what evidence is necessary to show inability to obtain it. This will create an evidentiary and interpretive gap that claimants must fill with contemporaneous medical records, referral histories, or system-level evidence, and decision-makers will exercise judgement in the absence of a statutory standard (s9(8)).

Certain surgical practices must be evidenced. Section 9(4) includes "muslin or cotton wrapping or packing, left in situ after a surgical procedure which involves or adjacent to the optic chiasm, at least 30 days before clinical onset or clinical worsening." Establishing this requires surgical operative notes, theatre logs, or implant/packing removal records that explicitly document retained material and its location relative to the optic chiasm. Absent that documentary proof, the factor cannot be satisfied by general assertion.

Intrathecal iophendylate exposure is specific. Section 9(6) singles out intrathecal myelogram or intrathecal treatment with iophendylate (Pantopaque or Myodil). These are specific historic agents and procedures; evidence must show the intrathecal administration and timing before clinical onset or worsening. The SoP offers no fallback for similar but different agents or techniques.

Subarachnoid haemorrhage timing must precede onset/worsening. Section 9(3) requires that subarachnoid haemorrhage or bleeding into the subarachnoid space occurred before clinical onset or clinical worsening. This makes clear that if a haemorrhage occurs after OA onset it cannot serve as the listed causal factor.

Cross-reference to other SoPs may change the applicable criteria. If a factor in section 9 refers to a disease or injury that is covered by another SoP, the other SoP’s factors apply (s11). Practitioners should therefore check whether an invoked factor is governed by a separate SoP and then examine that other SoP for potentially different or additional requirements.

The SoP does not create entitlements or procedural rules. The instrument functions purely as a medical-causation instrument; it does not set entitlements, payment rules, or appeal procedures. Outcomes therefore depend on how the VEA and MRCA apply the SoP within their established administrative frameworks (s3, s5, s8).

Death claims require a contribution to death. For death claims, the SoP defines death from OA as inclusive of death from a terminal event that was "contributed to by the person's OA" (s7(3)). The Schedule lists example terminal events. Practitioners must therefore show contribution by OA to the terminal event, not merely the presence of OA at death.

No penalties or sanctions included. The instrument contains no penalties or enforcement clauses; failure to satisfy a factor will simply affect claim outcomes under the parent statutes (s3, s5, s8).

In practice, these textual particulars create discrete evidentiary thresholds. Success depends on producing specific, contemporaneous clinical or service records that match the SoP’s enumerated factors and timing requirements, complying with the ARPANSA methodology where radiation is alleged, and addressing interpretative gaps (clinical worsening, appropriate clinical management) in evidence and expert opinion.

Compliance with this SoP is compliance with an evidentiary and medical causation standard that will be applied in determining claims under the VEA and MRCA. The SoP does not prescribe procedural steps, forms or tribunals; it prescribes medical factors and definitions. The practical steps below are drawn directly from the instrument’s text and identify the evidence and processes claimants and advisers should assemble to satisfy the SoP’s requirements.

1. Confirm statutory pathway and relevant service

• Ensure the claim is one to which section 120B of the VEA or section 339 of the MRCA applies (s5). If the claim is outside those statutory pathways, this SoP is not the authoritative instrument for OA causation.
• Establish that the person’s service qualifies as "relevant service" under the Schedule: eligible war service (other than operational service), defence service (other than hazardous service and British nuclear test defence service) under the VEA, or peacetime service under the MRCA (Schedule, relevant service). Obtain service records that demonstrate the relevant service period and nature.

2. Identify and document at least one qualifying factor

• Review section 9 and determine which factor(s) the claimant can realistically prove (s9(1)-(8)). The SoP requires at least one factor. Each factor entails specific documentary evidence:
  • Tuberculous leptomeningeal infection (s9(1)): obtain diagnostic records, microbiology, imaging, and hospital notes confirming tuberculous meningitis of the leptomeninges surrounding the optic chiasm or optic nerves.
  • Antibiotic treatment for tuberculous meningitis at least 30 days before onset/worsening (s9(2)): secure prescription records, inpatient treatment notes and dated clinicians’ entries showing start dates.
  • Subarachnoid haemorrhage before onset/worsening (s9(3)): neurological imaging reports, discharge summaries, and surgical notes demonstrating timing and diagnosis.
  • Retained muslin or cotton packing left in situ for at least 30 days following surgery involving/adjacent to the optic chiasm (s9(4)): obtain operative notes, theatre logs, implant/packing removal records, postoperative imaging showing retained material and dates.
  • Cumulative equivalent dose of at least 60 sieverts to the optic chiasm region (s9(5)): collect radiotherapy records, dosimetry, occupational radiation records and arrange for dose reconstruction in accordance with the ARPANSA guide specified in the Schedule (Schedule, cumulative equivalent dose).
  • Intrathecal myelogram or intrathecal iophendylate (Pantopaque or Myodil) before onset/worsening (s9(6)): secure radiology procedure notes and dated contrast administration records.
  • Inability to obtain appropriate clinical management before clinical worsening (s9(8)): compile referral histories, waiting lists, correspondence showing attempted access to care and contemporaneous clinical notes documenting timing and deterioration.

3. Establish timing and relation to relevant service

• For each factor, assemble evidence that the exposure or event occurred before the clinical onset or before the clinical worsening, observing specific timing thresholds (e.g., 30 day requirement where stated) (s9(2), s9(4)). For radiation, confirm exposure dates precede clinical onset/worsening (s9(5)).
• Demonstrate that the factor is related to relevant service as required by section 10(1). This may require linking the exposure or event to duties, locations or service activities recorded in service medical files or operational logs.

4. Address the clinical worsening limitation where applicable

• If relying on the "clinical worsening" limb, ensure the OA was suffered or contracted before or during relevant service and did not arise out of relevant service, as required by section 10(2). Provide baseline clinical documentation showing pre-service or in-service presence of OA and contemporaneous records that establish aggravation or material contribution by the listed factor.

5. Use prescribed technical methodology for radiation dose reconstructions

• For radiation-based claims, instruct experts to calculate "cumulative equivalent dose" exactly as defined in the Schedule, using the ARPANSA guide "as in force on 2 August 2017" and excluding normal background radiation exposure in Australia from the calculation (Schedule, cumulative equivalent dose). Ensure experts document the methodology and inputs in accordance with that guide.

6. Cross-check other Statements of Principles

• If a chosen factor refers to an injury or disease that is the subject of another SoP, obtain and apply the relevant SoP in accordance with section 11. For example, if TB meningitis is itself covered by another SoP, its factors must be applied as that SoP requires (s11).

7. Assemble expert opinion addressing causation on the balance of probabilities

• Obtain medical expert reports that tie the documented factor(s) to OA or death from OA on the balance of probabilities standard, in the language of s8. Experts should address timing, mechanism, and the extent to which the factor materially contributed to onset or worsening.
• Where the SoP leaves interpretative gaps (for example "appropriate clinical management" or "clinical worsening"), have experts explain their clinical criteria and link them to accepted practice and the claimant’s records.

8. Prepare documentary proof for administrative decision-makers

• Provide clear, dated medical records, service records, operative notes, radiology reports and expert reports that directly correspond to items listed in section 9. Ensure that the evidence addresses both the factual occurrence of the factor and its relationship to relevant service (s9, s10(1)).

9. Anticipate cross-examination on technical points

• For radiation claims, ensure the dose reconstruction report includes the ARPANSA guide reference and method steps so that assessors can verify compliance with the Schedule’s definition.
• For surgical retention or intrathecal contrast exposures, ensure procedural documentation is contemporaneous and explicit.

10. Consider timing relative to repeal and commencement

• The SoP commences on 24 November 2025 and repeals the earlier 2016 SoP (s2, s4). For claims spanning the repeal/commencement, clarify with the relevant decision-maker which SoP applies and prepare evidence accordingly.

11. Address the death definition when relevant

• For death claims, show that the terminal event listed in the Schedule (for example pneumonia, respiratory failure, cardiac arrest) was contributed to by OA (s7(3); Schedule, terminal event). This requires a medical opinion linking OA to the causal chain leading to death.

12. Administrative follow-through

• Submit the assembled medical and service evidence with the claim under the forms and processes established by the VEA/MRCA administrative systems. The SoP does not set forms or filing requirements; follow the parent statute’s processes.

In practice, compliance requires targeted evidence gathering mapped to a specific factor in section 9, firm chronology tying that factor to relevant service, and experts who apply the SoP’s required technical method where applicable (notably for radiation). Attention to specific timing thresholds and to the Schedule’s technical requirements is essential to meeting the SoP’s criteria (s9, s10, Schedule).