Statement of Principles concerning osteogenesis imperfecta (Balance of Probabilities) (No. 54 of 2023)

This SoP relies on a small set of tightly defined legal and medical concepts. Those concepts determine both the legal scope of the instrument and how decision-makers will test claims.

Osteogenesis imperfecta (OI). The instrument defines OI as “a group of genetic disorders of bone formation that typically involve low bone mass, bone fragility and an increased propensity to fracture” (s7(2)). The instrument expressly displaces reliance on the ICD‑10‑AM label for definitional purposes: although the condition carries ICD‑10‑AM code Q78.0, the SoP adopts the statutory text definition at subsection 7(2) as the operative meaning (s7(3)-(4)).

Death from osteogenesis imperfecta. Death is included where a terminal event or condition was “contributed to by” a person’s OI (s7(5)). The Schedule defines “terminal event” as proximate or ultimate causes of death and lists examples including pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (Schedule 1). The instrument therefore contemplates both direct mortality from OI complications and deaths from terminal events to which OI is a contributing factor.

Relevant service. “Relevant service” is defined in the Schedule and is limited to:

• eligible war service (other than operational service) under the VEA;
• defence service (other than hazardous service and British nuclear test defence service) under the VEA; or
• peacetime service under the MRCA (Schedule 1).

This definition constrains the classes of service to which the SoP’s factors may be attached and therefore limits the pool of claimants for whom the SoP will be operative (s5, Schedule 1).

Causation standard. The instrument’s title and s8 indicate that the RMA set the SoP on the “balance of probabilities.” Subsection 8 records the RMA’s view that, on the sound medical‑scientific evidence available, it is “more probable than not” that OI and deaths from it can be related to relevant service. The RMA therefore frames the SoP to be used where decision-makers assess causation on that standard.

Factors required. The SoP contains a single mandatory factor that a claimant must satisfy: “inability to obtain appropriate clinical management for osteogenesis imperfecta” (s9(1)). Section 10 then governs how that factor must be related to relevant service. Subsection 10(1) requires that any factor in s9 must be related to the person’s relevant service. Subsection 10(2) limits the operation of the s9(1) factor to establishing material contribution to, or aggravation of, OI only where the OI was suffered or contracted before or during (but did not arise out of) relevant service. The instrument therefore distinguishes between OI that arises out of service and OI that pre‑existed or was present during service; the listed factor is directed to the latter scenario and to material contribution or aggravation.

Inter-SoP interaction. Section 11 provides that when a factor in this SoP refers to an injury or disease already covered by another SoP, the factors in that other SoP apply according to its terms as in force from time to time. This produces a regulatory architecture in which SoPs cross‑refer and decision-makers must consult multiple instruments when factors overlap.

Authority and application. The RMA made the instrument under its statutory power in s196B(3) of the VEA (s3). The instrument applies to claims that engage section 120B of the VEA or section 339 of the MRCA (s5), so it is intended for use by decision-makers administering entitlements under those provisions.

Repeal and commencement. The 2015 SoP is formally repealed (s4). The instrument takes effect on 23 May 2023 (s2).

These concepts set the legal test decision-makers must apply: identify OI per s7(2), determine whether at least one factor in s9 is present, assess whether the factor is related to relevant service per s10, and where necessary consult other SoPs under s11. The instrument does not specify evidentiary rules beyond the RMA’s framing of the causation standard (s8), nor does it prescribe operational definitions of “appropriate clinical management” or procedures for measuring “material contribution” or “aggravation.”

Primary affected persons and decision-makers

• Veterans and members of the Forces who submit claims under the VEA or MRCA. The SoP applies specifically to claims to which section 120B of the VEA or section 339 of the MRCA applies (s5). Those claimants will be required to meet the SoP’s factor(s) and relationship-to-service requirements to establish a connection between OI or death from OI and their relevant service.

• Decision-making agencies and officials administering the VEA and MRCA. The RMA sets the SoP as a tool for adjudication by decision-makers under the Acts (s3, s5). Those officials will apply the SoP’s definition of OI, the listed factor(s) in s9, and the relationship limits in s10 when determining whether OI is connected to relevant service.

Secondary affected parties

• Medical practitioners whose clinical assessments are relied upon in claims. The single substantive factor that can establish a connection, “inability to obtain appropriate clinical management for osteogenesis imperfecta” (s9(1)), will require medical evidence of clinical management needs and access or lack of access. Practitioners providing records, opinions or expert reports will shape how decision-makers evaluate whether the factor existed.

• Parties whose conditions are referenced by other SoPs. Section 11 creates cross-SoP application: if the s9 factor refers to an injury or disease covered by another SoP, the factors in that other instrument govern. That may broaden the circle of relevant medical or claims stakeholders where overlap exists.

Groups excluded or constrained by definition

• Persons whose service does not fall within the SoP’s “relevant service” definition (Schedule 1) are not within the instrument’s scope for this purpose. The Schedule defines relevant service as specific categories that explicitly exclude some kinds of service: eligible war service other than operational service; defence service other than hazardous service and British nuclear test defence service; or peacetime service under the MRCA (Schedule 1). The textual exclusions mean that claimants whose service falls within operational service, hazardous service or British nuclear test defence service categories may not qualify under this SoP’s framing.

• Persons whose OI “arose out of” relevant service. Section 10(2) clarifies that the listed factor in s9(1) applies only to material contribution to, or aggravation of, OI where the OI was suffered or contracted before or during relevant service but did not arise out of relevant service. Thus the factor as drafted is targeted at pre‑existing or contemporaneous-but-not‑arising‑out‑of‑service OI rather than conditions that originated because of service. The instrument does not state what tests are used to classify OI as having “arisen out of” service; decision-makers will apply the SoP in the context of those determinations.

Institutional actors

• The Repatriation Medical Authority. The RMA both made and published the SoP under its statutory power (s3). The instrument’s repeal of the 2015 SoP and its adoption of the 2023 text are acts of RMA regulation; the RMA sets the medical-scientific view expressed in s8.

Financial and administrative consequences

• The instrument itself does not set out payments, services or administrative processes. However, it materially affects the assessment threshold for entitlement determinations governed by the VEA and the MRCA by identifying the medical factors that must exist for a connection to service. That alters the evidentiary path to entitlement decisions under those statutes (s5). The government (through the relevant decision-making agencies) and claimants are the principal parties who will experience administrative or financial consequences tied to the instrument’s application.

In short, the SoP most directly affects claimants pursuing VEA/MRCA entitlements for OI, the decision-makers who assess those claims, the medical practitioners who supply evidence, and other SoPs that cross‑reference the same clinical issues. The Schedule’s definition of “relevant service” and s10(2)’s timing rule narrow the population to which the single s9 factor can be applied.

Duties created by the instrument

• RMA’s duty to define. The RMA has exercised its statutory role under s196B(3) of the VEA to produce this SoP (s3). The instrument embeds the RMA’s medical‑scientific view that the condition can be related to relevant service on the balance of probabilities (s8).

• Duty on decision-makers to apply the SoP in relevant claims. The instrument is made to apply to claims under section 120B of the VEA and section 339 of the MRCA (s5). Although the instrument does not itself impose a duty on any named decision‑maker beyond the RMA, by statute SoPs produced under s196B(3) are intended to be applied by decision-makers under the relevant Acts; therefore officials deciding claims under the referenced sections will be required to regard this SoP when assessing whether OI is connected with service. The instrument prescribes the factual elements that must exist (s9) and the relationship-to-service requirement (s10), which decision-makers will have to test.

• Duty to interpret OI according to the instrument’s definition. Where OI is in issue, it must be understood for adjudicative purposes as the definition provided at subsection 7(2) rather than merely by reference to an ICD code (s7(2)-(4)).

Rights or evidentiary thresholds for claimants

• Right to have causation assessed on a specified standard. The instrument states the causation framing the RMA applied: “on the sound medical‑scientific evidence available, the RMA is of the view that it is more probable than not that osteogenesis imperfecta and death from osteogenesis imperfecta can be related to relevant service” (s8). This places the RMA’s statement in terms of the balance of probabilities standard. Claimants therefore engage with an instrument that was set on that standard; it does not, however, alter the statutory standard of proof in the Acts themselves.

• Burden to establish at least one of the named factors. Section 9 sets a required precondition to connection: at least one of the listed factors must exist. In practice, claimants therefore must adduce evidence demonstrating the existence of the factor “inability to obtain appropriate clinical management for osteogenesis imperfecta” (s9(1)), and show its relation to relevant service under s10.

Constraints and limits on rights

• Temporal and causal limits in s10. Subsection 10(2) limits the capacity of s9(1) to establish material contribution or aggravation only where OI was suffered or contracted before or during relevant service but did not arise out of relevant service. That is, the factor is not framed to prove that service caused a new condition; it is instead focused on contribution or aggravation of a pre‑existing or contemporaneous condition due to inability to access appropriate clinical management during relevant service.

• Cross‑SoP application under s11. When the s9 factor refers to an injury or disease covered by another SoP, the claimant is subject to the terms of that other SoP as in force. This means the claimant’s rights and the factual architecture of the claim can be affected by other, possibly more detailed, SoPs.

What the instrument does not do (important absences)

• It does not create statutory entitlements or payment rules. The SoP does not itself grant benefits or prescribe administrative remedies; it is an evidentiary and causal framework to be used in assessing claims under the VEA and MRCA (s5, s3).

• It does not define “appropriate clinical management”, “material contribution”, or “aggravation”, nor does it state procedural or evidentiary rules for proving the factor. Those matters remain for decision-makers, who will apply the SoP within the procedural rules of the VEA and the MRCA.

• It does not set penalties, compliance obligations, or enforcement mechanisms directed at private actors. The instrument functions as a decision-making aid rather than a standalone regulatory imposition.

In summary, the SoP imposes an evidentiary duty on claimants to show one or more of the listed factors (in practice, the sole listed factor), requires decision-makers to apply the RMA’s definitions and causal framing (s7-s11), and constrains the circumstances under which the inability-to-obtain-management factor can support a finding of material contribution or aggravation (s10(2)). The rights to have a condition assessed are framed around those duties rather than creating new statutory benefits.

This instrument contains no penalties, offences, or direct enforcement provisions. It is a Statement of Principles created under subsection 196B(3) of the VEA and is structured as a medico‑legal instrument for determining whether osteogenesis imperfecta or death from it can be connected to relevant service (s3, s8). The SoP’s enforcement mechanism is therefore institutional and administrative rather than punitive.

How application and “enforcement” operate in practice under the instrument

• Administrative application in claims decisions. The SoP will be applied by decision-makers determining claims under section 120B of the VEA or section 339 of the MRCA (s5). Those decision-making processes, including any administrative sanctions, appeals or review rights, are governed by the VEA and the MRCA and their associated procedures. The SoP itself does not prescribe those procedures.

• Repeal and replacement as regulatory instruments. The RMA’s repeal of the 2015 SoP (s4) and the promulgation of this 2023 instrument alters the body of medical-scientific guidance decision-makers must use. That is the principal operational change: decision-makers must apply the 2023 SoP in place of the 2015 instrument from the commencement date (s2-s4). Compliance by agencies consists primarily of adopting the new SoP in the adjudicative process.

• Cross-reference enforcement via other SoPs. Section 11 creates an interlocking network of SoPs. Where a factor in this SoP refers to an injury or disease covered by another SoP, the other SoP’s factors apply as in force from time to time. Thus compliance with the SoP may require reference to other instruments, and administrative consistency is enforced by internal policy and adjudicative practice rather than statutory sanction contained in this instrument.

Absence of criminal, civil or administrative sanctions in the instrument

• No fines or penalties. The instrument does not create fines, penalties or offences for individuals or institutions.

• No obligations on providers or third parties to take or refrain from action. The instrument does not impose duties on hospitals, medical practitioners, employers, or others to provide treatment, to report, or to alter conduct; its function is to provide a causation framework for claims assessment.

Implication for oversight, review and dispute

• Disputes over application and interpretation will be resolved within the statutory review mechanisms of the VEA and MRCA and their administrative appeal pathways, not within the SoP. The SoP may be litigated or contested as part of a claim, but the instrument itself contains no procedural enforcement text. The instrument’s legal effect rests in its role as the RMA’s determination under subsection 196B(3), which decision-makers are required to consider.

In short, the instrument enforces nothing by coercive means; instead it shapes administrative decision-making under the VEA and MRCA, and the operational enforcement of its content happens through the adjudicative processes and the applicable review mechanisms under the parent Acts, none of which are specified in this instrument.

The SoP sits within the statutory architecture of the VEA and MRCA. The instrument itself identifies those interactions and leaves the broader procedural and substantive entitlements to the parent Acts.

Primary statutory relationships

• Made under the VEA. The instrument is made under subsection 196B(3) of the VEA (s3). That sub-section is the enabling provision for the RMA to determine Statements of Principles. As such, the SoP is a statutory instrument that will be applied in the adjudication of claims under the VEA’s decision-making framework.

• Application to claims under specified provisions. The SoP applies to a claim to which section 120B of the VEA or section 339 of the MRCA applies (s5). Those cross-references indicate that the SoP is a tool used in determinations under those named provisions; the instrument does not itself reproduce or alter the text of those sections. Users must consult the VEA and the MRCA to understand procedural rules, entitlement schedules, or appeal rights that follow from a SoP-based finding.

Interplay with other Statements of Principles

• Cross-referencing SoPs. Section 11 explicitly provides that where a factor in this SoP refers to an injury or disease already covered by another SoP, the factors in that other SoP apply according to its terms as in force from time to time. This networked structure requires decision-makers to reconcile and apply multiple SoPs where clinical overlap exists. Practically, an adjudicator assessing whether an inability to obtain appropriate clinical management relates to another condition will need to open and apply the relevant SoP(s).

Relationship to ICD‑10‑AM and clinical coding

• ICD‑10‑AM code is noted but not determinative. Section 7(3)-(4) records that while osteogenesis imperfecta attracts ICD‑10‑AM code Q78.0, the definition used for legal purposes is the statutory text at s7(2). The SoP thus references clinical coding for identification but prioritises a descriptive clinical definition; decision-makers should not equate presence of the ICD code alone with meeting the SoP’s definitional requirement.

Interplay with MRCA definitions and coverage

• Schedule definitions refer to MRCA. The Schedule supplies definitions including MRCA and ‘peacetime service under the MRCA’ for the term “relevant service” (Schedule 1). Where claims arise under the MRCA, the SoP will be applied in conjunction with MRCA concepts of peacetime service and related thresholds for entitlement, but the instrument does not restate MRCA procedures or entitlements.

Limits imposed by the SoP’s definitions

• Narrowing of “relevant service”. The Schedule’s definition of relevant service is textual and selective (eligible war service other than operational service; defence service other than hazardous service and British nuclear test defence service; peacetime service under the MRCA). This implies that other statutory categories of service are outside the SoP’s intended application. To determine whether a person’s service falls within the SoP’s scope, decision-makers must map the claimant’s service type against the Schedule’s list and the parent Acts’ definitions.

Absence of direct conflict resolution provision

• No express conflict clause. The instrument does not include an express rule resolving conflicts between the SoP and other statutory or regulatory instruments; its interaction is governed by the RMA’s role and the parent Acts’ operation. When multiple SoPs or statutory provisions intersect, decision-makers will need to apply statutory interpretation and the relevant administrative law frameworks to resolve inconsistencies.

Administrative practice implications

• Application as an interpretive aid. The SoP is an interpretive and evidential instrument to be used within the VEA/MRCA decision-making machinery. Its legal force is derived from the enabling statute and the RMA’s formal determination; it is not, on its face, a self-executing entitlement.

In sum, the SoP is embedded in the VEA/MRCA landscape: it both depends on and informs those Acts. The instrument cross-references other SoPs for overlapping conditions, clarifies definitional relationships with clinical coding, and limits its own applicability through a precise Schedule definition of relevant service. It does not displace or redefine procedural rights or entitlements that the parent Acts establish; those must be read alongside the SoP.

This instrument contains limited but specific amendment history communicated within its own text. It is principally a replacement instrument and not a series of incremental amendments.

Replacement of earlier instrument

• Repeal of 2015 SoP. The instrument expressly repeals the Statement of Principles concerning osteogenesis imperfecta No. 36 of 2015 (Federal Register of Legislation No. F2014L01850), which had been made under subsection 196B(3) of the VEA (s4). The 2023 SoP therefore supersedes that earlier instrument and becomes the operative RMA determination from the commencement date.

Dates and commencement

• Date of instrument and commencement. The instrument is dated 24 April 2023 (front matter) and commences on 23 May 2023 (s2). The seal attestation and date in the instrument show the administrative steps the RMA took in making the instrument. There is no schedule of staged commencement; the instrument takes effect on the single specified date.

Absence of further amendment entries

• No subsequent amendments recorded. The instrument contains no internal amendments, transitional provisions, or future amendment mechanisms. It does not record prior amendment history beyond the express repeal of the 2015 instrument. It also does not prescribe review or sunset clauses.

Operational implications of the replacement

• Transition from the 2015 instrument. Because the 2015 SoP is repealed, decision-makers must now adopt the 2023 SoP for all claims to which the instrument applies from the commencement date. The instrument provides no transitional guidance for claims in progress at the date of repeal or for retrospective application. The absence of transition rules leaves implementation practice to the administrative framework of the VEA and MRCA and to agency policy about treatment of pending claims.

RMA’s capacity to produce future amendments

• RMA’s enabling power retained. The instrument was made under subsection 196B(3) of the VEA (s3), which retains the RMA’s statutory capacity to determine SoPs. The instrument itself does not limit the RMA’s power to issue further SoPs or amendments in future, nor does it prescribe criteria for amendment. The RMA may therefore produce future revisions as it deems appropriate under its statutory powers.

Recordkeeping and publication

• Federal Register listing. The instrument references the Federal Register number of the repealed instrument. The 2023 SoP similarly appears as a formally made instrument with an attested seal. The instrument does not set out internal publication or notification rules beyond the formal attestation, but its status as an RMA determination indicates it will be accessible to decision-makers and claimants.

In short, the amendment history recorded in the instrument is confined to the repeal of the 2015 SoP and the making and commencement dates of the 2023 instrument. There are no staged amendments, transitional provisions, or sunset clauses included in the instrument itself.

The instrument contains no litigation history. It does not reference any judicial decisions, appeals, tribunal rulings, or precedential case law in its text. There are no enumerated cases, no account of prior litigation over the 2015 SoP, and no mention of disputes that influenced its drafting.

What the absence of litigation history implies for users

• No judicially distilled interpretation available within the instrument. Because the instrument does not include litigation history or cited cases, users (claimants, decision-makers, legal advisers) do not have guidance from the instrument about how its provisions have been interpreted by courts or tribunals. That means initial litigation or administrative review that raises questions about interpretation,such as the meaning of “inability to obtain appropriate clinical management”, the scope of “relevant service”, or application of s10(2)’s material contribution/aggravation requirement,will likely rely on statutory interpretation principles and expert evidence without a body of SoP-specific precedent built into the instrument.

• Potential for future disputes over definitions and thresholds. The instrument leaves undefined several potentially contested terms and concepts: what constitutes “appropriate clinical management”, how to establish an “inability to obtain” it, and what evidence satisfies the requirement that a factor be “related to the relevant service” (s9, s10). Litigation or tribunal review may be the vehicle through which those words are given operational meaning in the context of the VEA and MRCA.

• Interaction with other SoPs possibly litigated elsewhere. Section 11’s cross‑reference to other SoPs raises the prospect that litigation over one SoP could affect interpretation of this instrument if its factors refer to other conditions or injuries. The SoP does not record any such litigation history.

Administrative review pathways remain primary

• Administrative review and appeals under the VEA and MRCA will be the usual routes for contesting decisions that apply the SoP. Though the instrument does not state procedural rights, the VEA and MRCA frameworks provide the appeal and review infrastructure for testing application of SoPs. Any litigation history will therefore most likely arise through the statutory appeal channels for decisions under those Acts.

In summary, the instrument does not contain or summarise any litigation history. Absent judicial or tribunal interpretations recorded in the instrument, claimants and decision-makers must apply the SoP’s text and rely on the underlying Acts’ review regimes to resolve interpretive disputes.

The instrument’s brevity and tightly limited structure create several practical traps-in-waiting for claimants, decision-makers and advisers. These are not value judgments; they are concrete points where the SoP’s wording may produce unintended limits or evidentiary hurdles.

Only one enumerated factor (s9(1)). Section 9 requires that “at least one of the following factors must exist” and then lists a single factor: “inability to obtain appropriate clinical management for osteogenesis imperfecta.” The practical effect is that a claimant cannot rely on any other factor under this SoP to establish a connection. If a claimant’s factual case is not primarily about inability to obtain care, the SoP does not provide alternative medical pathways to connection. The instrument thus concentrates the evidentiary focus on access-to-care during relevant service rather than on, for example, occupational exposures or other service-related insults.

Narrow temporal application for the listed factor (s10(2)). The inability-to-obtain-management factor is explicitly limited to establishing material contribution to, or aggravation of, OI where the OI “was suffered or contracted before or during (but did not arise out of) the person’s relevant service.” This wording creates a three‑state test:

• If OI arose out of relevant service, s9(1) is not framed to apply to that causal pathway;
• If OI pre‑existed or was already present during service, s9(1) can apply but only to material contribution or aggravation caused by inability to obtain appropriate clinical management;
• If OI was suffered after service, the s9(1) factor as drafted may not apply.

That sequencing is a potential gotcha: claimants whose disease originated during service and is characterised as arising out of service may be unable to use the inability-to-obtain-care pathway. The instrument does not explain how “arose out of” is to be distinguished from “suffered or contracted during” relevant service.

Undefined key terms. The instrument does not define “appropriate clinical management,” “inability to obtain,” “material contribution,” or “aggravation.” Those are legally and medically significant concepts and their absence imposes interpretive burdens on decision-makers and claimants. Illustrative consequences include:

• Disputes about what baseline standard of care counts as “appropriate clinical management” for genetically mediated OI;
• Questions about whether temporary lapses in access during service suffice as an “inability to obtain” care;
• Uncertainty about quantitative or qualitative thresholds for “material contribution” or “aggravation.”

ICD code reference is subordinate to statutory definition (s7(3)-(4)). The instrument notes the ICD‑10‑AM code Q78.0 but instructs that the legal meaning of OI is that provided in s7(2). Misreliance on a coding entry without attention to the statutory text may lead to erroneous claim framing.

Scope of “relevant service” narrows applicant universe (Schedule 1). The Schedule defines relevant service in a way that excludes certain categories (for example, the parenthetical “other than operational service” in relation to eligible war service and “other than hazardous service and British nuclear test defence service” in relation to defence service). Practitioners must closely map a claimant’s service history against this definition; claimants whose service falls into excluded subcategories risk being outside the SoP’s scope even if their condition is otherwise within the medical definition.

Cross-SoP dependencies (s11). Section 11 requires that, if a factor refers to an injury or disease covered by another SoP, that other instrument applies as in force from time to time. This can create interpretive complexity where multiple SoPs must be consulted; for example, if the inability-to-obtain-management factor references an injury that is itself regulated by a more detailed SoP, the claimant must meet the other SoP’s factors as well. Practitioners should be alert to cross-references and evolving versions of the other SoPs.

No transitional provisions after repeal (s4). The instrument repeals the 2015 SoP but contains no transitional guidance for claims in progress at the time the new SoP took effect. Agencies deciding pending claims must therefore decide whether to apply the new SoP, the old one, or some administrative transitional approach consistent with the VEA/MRCA; that choice may affect outcomes.

No procedural or evidentiary guidance. The SoP sets the causal factors but does not state evidentiary standards or required forms of proof beyond the RMA’s framing of the causation standard (s8). Practitioners must rely on procedural rules in the VEA and MRCA and on administrative practice. This absence can produce contested procedural debates over admissibility, expert evidence, or weight to be attached to service records and medical testimony.

Examples embedded in the Schedule. The Schedule’s definition of “terminal event” includes specific examples (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). While illustrative, these examples are not exhaustive; claimants and decision-makers sometimes mistake example lists for exhaustive lists. The instrument’s text does not explicitly state that the list is non‑exhaustive, but the heading “includes the following” suggests exemplars rather than a closed set.

In sum, the principal practical pitfalls arise from the SoP’s narrow factor list, timing constraints, undefined key terms, cross‑SoP dependencies, restricted definition of relevant service, and lack of procedural or transitional guidance. Advisers should prepare to address these textual lacunae when framing claims or defending decisions that engage this SoP.

This section explains what claimants and decision-makers must demonstrate in order to give effect to the SoP’s requirements and how to structure evidence and decision-making around the instrument’s text. The instrument itself prescribes the elements; it does not prescribe forms or documents. The following is a practical layout, grounded in the SoP’s wording.

Step 1 , Establish the medical condition as defined in the SoP (s7(2), s7(3)-(4))

• The claimant must show that the person has osteogenesis imperfecta as defined by subsection 7(2): a group of genetic disorders of bone formation characterised by low bone mass, bone fragility and increased propensity to fracture. The instrument specifies that the statutory definition in s7(2) is the operative meaning even though an ICD‑10‑AM code exists (s7(3)-(4)).
• The SoP does not prescribe particular diagnostic tests or genetic confirmation requirements. The decision-maker will accordingly assess medical records and expert opinion against the descriptive criteria in s7(2).

Step 2 , If claiming death from OI, tie the death to a terminal event contributed to by OI (s7(5), Schedule 1)

• If the claim is for death from OI, show that the terminal event or condition that caused death was contributed to by the person’s OI (s7(5)).
• The Schedule defines “terminal event” and gives examples (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). The claimant should present cause-of-death documentation and medical evidence addressing contribution by OI.

Step 3 , Demonstrate that at least one factor in s9 exists (s9(1))

• The SoP’s sole listed factor is inability to obtain appropriate clinical management for OI (s9(1)). To comply, claimants must adduce evidence that such inability existed.
• The instrument does not define “appropriate clinical management” or the quantum or kinds of proof required for “inability to obtain.” Practically, relevant materials include medical records documenting need for treatment, contemporaneous records showing lack of access to that treatment during relevant service, communications about care access, and expert opinion linking lack of clinical management to disease progression or aggravation. The SoP leaves the assessment of sufficiency to the decision-maker.

Step 4 , Show relationship to relevant service (s10(1)-(2), Schedule 1)

• The SoP requires that any factor in s9 be related to the person’s relevant service (s10(1)). The Schedule defines “relevant service” narrowly: eligible war service (other than operational service) under the VEA; defence service (other than hazardous service and British nuclear test defence service) under the VEA; or peacetime service under the MRCA (Schedule 1).
• If relying on s9(1), claimants must establish that inability to obtain appropriate clinical management occurred in connection with that relevant service and that it materially contributed to or aggravated the OI where the OI pre‑existed or was present during service but did not arise out of it (s10(2)). For example, evidence that a service member could not access specialist treatment while posted and that this lack of care materially worsened the OI would be directly relevant.

Step 5 , Attend to cross-SoP linkages (s11)

• If the factor relied upon refers to an injury or disease covered by another SoP, the claimant must satisfy the terms of that other SoP as in force (s11). Practitioners should identify any cross‑referenced SoPs early and ensure compliance with their factors.

Step 6 , Use the correct standard of proof and frame evidence accordingly (s8)

• The RMA frames the SoP on the balance of probabilities: the RMA is of the view that “it is more probable than not” that OI and death from it can be related to relevant service (s8). In practice, claimants should bear this standard in mind when compiling evidence; they must persuade the decision-maker on the usual civil standard that the factor(s) and relationship to service are more likely than not to have existed.

Evidence types to assemble (instrument does not mandate any but these align with the SoP)

• Medical records diagnosing OI, including clinical notes, imaging, fracture history and genetic testing where available, referenced to the s7(2) definition.
• Specific documentation of attempts to obtain clinical management and records showing denial, lack of availability, or inability to access appropriate services during the period of relevant service.
• Service records (postings, medical centre attendance, leave records) demonstrating where and when the inability to obtain care occurred and tying it to the defined “relevant service.”
• Expert medical opinion addressing causation, material contribution or aggravation, and the clinical link between lack of management and disease progression or complications, bearing in mind that the SoP itself does not prescribe expert proof but relies on medical‑scientific evidence (s8).
• For death claims, cause-of-death certificates, coroner’s findings and expert evidence on contribution of OI to the terminal event.

Administrative practice checklist for decision-makers

• Confirm the claim falls within the scope of section 120B of the VEA or section 339 of the MRCA (s5); reconcile the claimant’s service history with Schedule 1’s definition of relevant service.
• Establish the diagnosis in terms of s7(2) rather than relying solely on ICD coding (s7(3)-(4)).
• Test whether the claimant has proven, on the balance of probabilities, the existence of the s9 factor(s); because the SoP lists only one factor, ensure the case is developed to address inability to obtain appropriate clinical management.
• Assess whether s10(2) limits apply (i.e. OI pre‑existing or present during service but not arising out of it) and whether the inability to obtain care materially contributed to or aggravated the condition.
• Where s11 applies, identify and apply the factors in the other SoP(s) as in force.
• Document reasoning clearly, including how the SoP was applied and the evidentiary weight given to clinical and service records.

Practical tips and compliance risks

• Disaggregate the causation question: first establish the clinical diagnosis per s7(2), then prove lack of access to care (s9(1)), then show the temporal relationship and the material contribution/aggravation element under s10(2).
• Do not assume ICD coding is determinative; cite s7(3)-(4) when aligning diagnostic evidence with the SoP’s textual definition.
• If a claimant’s service includes operational, hazardous or British nuclear test defence elements, carefully determine whether the Schedule’s exclusion language places the case outside the SoP’s scope.
• Anticipate cross-SoP complexity: where references trigger other SoPs, gather and align evidence to those instruments’ requirements.

The instrument does not provide procedural forms or specify what documents are mandatory. Compliance therefore requires careful evidence assembly aligned to the textual elements the RMA has set out: the descriptive diagnosis (s7), the single factor (s9(1)), the relation to relevant service (s10) and any cross‑SoP obligations (s11). Decision-makers must apply the SoP within the broader procedural and substantive framework of the VEA and the MRCA.