Statement of Principles concerning Parkinson disease and Secondary Parkinsonism (Balance of Probabilities) (No. 88 of 2025)

The Statement operates as an evidentiary rulebook for service-connection in claims relating to Parkinson disease, Secondary Parkinsonism and death where those conditions contributed to death. Key conceptual elements are: (1) the legal basis and scope, (2) the medical definition of the covered conditions, (3) the discrete list of causal or aggravating factors and the temporal windows attached to them, and (4) the requirement that any listed factor be related to relevant service as defined in the Schedule.

Legal basis and scope. The instrument is made under s196B(3) VEA (s3). It explicitly applies to claims under s120B VEA and s339 MRCA (s5). It repeals the prior 2016 Statement covering the same conditions (s4), thereby providing the authoritative list of factors from its commencement date (s2).

Medical definitions. Parkinson disease is defined by clinical features (bradykinesia, rigidity, resting tremor and/or postural instability), typical progression, response to levodopa and non‑motor symptoms, along with pathological hallmarks such as degeneration of dopaminergic neurons in the substantia nigra and alpha-synuclein‑associated Lewy bodies; the definition expressly excludes Secondary Parkinsonism and several other primary neurodegenerative syndromes (s7(2) Parkinson disease). Secondary Parkinsonism is defined as an acquired movement disorder caused by exogenous factors that interfere with dopaminergic transmission in the nigrostriatal system, with the same core clinical features, and it expressly excludes Parkinson disease and other named causes (s7(2) Secondary Parkinsonism).

Causal and aggravating factors. Section 9 sets out alternative factors; the presence of at least one satisfies the instrument’s requirements for relating the condition to service on the balance of probabilities. The factors are concrete and specific. They include traumatic brain injury with precise timing thresholds (for Parkinson disease: moderate to severe TBI at least 15 years before clinical onset, or within six months before clinical worsening; for Secondary Parkinsonism: moderate to severe TBI within six months before onset or worsening) (s9). Toxic exposures are regulated by cumulative exposure thresholds (for example, inhalation or skin contact with carbon disulphide for at least 500 cumulative hours within 10 years before worsening; exposure to manganese for at least 500 cumulative hours within 10 years before worsening; methanol/ethylene glycol intoxication within six weeks before worsening) (s9). Specific infectious and vascular events are included with explicit timing windows (for example cerebrovascular accident), and for many vascular diseases the instrument requires contemporaneous neuroimaging findings of white matter lesions, haemorrhage or infarction (s9).

Temporal windows and cessation effects. The instrument distinguishes between onset and clinical worsening, and imposes different timing thresholds for onset and for worsening depending on the factor and whether the condition is Parkinson disease or Secondary Parkinsonism (s9). It also sets out rules for medication-related causation and aggravation with explicit minimum exposure durations and time to cessation of symptoms after stopping the drug. For example, for Secondary Parkinsonism, a medication-associated development requires at least 14 days of continued treatment and cessation of the condition within six months of stopping (s9). For clinical worsening related to medication, the PD provisions require at least three days’ treatment and cessation of worsening within six weeks after discontinuation (s9).

Definitions as evidentiary anchors. Schedule 1 provides operational definitions that will be applied when assessing claims. Those include definitions for acute cholinergic poisoning, organophosphorus ester (with a list of named agents), regular smoking habit (at least 5 pack-years in a continuous five-year period), one pack-year conversion rules (including a conversion to grams for non-cigarette tobacco), neuroimaging findings, hypoxic cerebral insult, total parenteral nutrition, terminal event and others. These definitions set the boundary conditions for assessing whether a factor exists and are therefore central to the practical evidentiary enquiry.

Inter-instrument interaction. Section 11 requires that where a factor in this Statement of Principles refers to an injury or disease already covered by a separate Statement of Principles, the factors in that other Statement apply in accordance with its terms. That cross-reference creates dependencies across Statements and means a decision-maker must consult other Statements where factors invoke other diagnosed conditions.

Primary parties affected by the Statement are claimants (veterans and members of the Forces) seeking to establish a link between Parkinson disease, Secondary Parkinsonism or death from those conditions and their relevant service, and the administrative decision-makers who apply the Statement when adjudicating claims under the VEA and MRCA (s3, s5). Relevant service is defined in the Schedule to include eligible war service (other than operational service), defence service (other than hazardous service and British nuclear test defence service) pursuant to the VEA, and peacetime service under the MRCA. The instrument therefore affects claimants whose service falls into one of these defined categories (Schedule 1 relevant service).

Medical practitioners and diagnosticians will be affected in practice because the Statement specifies clinical, pathological and investigational anchors required to establish the listed factors. For example, the requirement for neuroimaging (MRI or CT) findings to demonstrate cerebral white matter lesions, haemorrhage or infarction in the presence of specified cerebral vessel diseases means that imaging and radiology reports will be central evidence in many claims (s9; Schedule 1 neuroimaging definition). Clinicians preparing evidence will need to link the timing of the medical event, imaging or toxic exposure to the claimant’s period of relevant service and to the dates of clinical onset or worsening.

Employers, former employers, and workplace health and safety record-holders may be called on to produce records showing cumulative exposures, rosters, job descriptions or other documents that demonstrate time spent in mining, smelting, welding, or enclosed-space exposure to carbon disulphide. The Statement sets cumulative-hours thresholds (for example 500 hours for manganese and carbon disulphide exposure within specified windows), so proof of hours or attendance is material (s9).

Administrative bodies within the Department of Veterans’ Affairs and the Military Rehabilitation and Compensation framework are affected because they must apply the Statement when determining entitlement under s120B VEA and s339 MRCA. Those application provisions mean the Statement is an input to decision-making processes, evidentiary standards and potentially to the scale and cost of claims administration. The Statement does not itself create entitlement nor does it specify payments; rather, it establishes which factors, if present and related to relevant service, satisfy the Repatriation Medical Authority’s opinion that a condition can be service‑connected on the balance of probabilities (s8).

Indirectly, pharmaceutical suppliers and prescribers may be implicated where the listed medications in the specified list appear in a claimant’s history. The instrument lists a wide range of medications and drug classes; presence of those drugs in a claimant’s treatment history with the timing and duration shown in s9 can be decisive in establishing causation or contribution.

Finally, since the instrument repeals the 2016 Statement, claimants and decision-makers with matters that were previously assessed under the older Statement should be aware that the 2025 Statement is the operative instrument from its commencement date (s4, s2), and that cross-references to other Statements may now be necessary for factors that overlap other disease instruments (s11).

The Statement itself imposes no criminal penalties and does not create statutory duties beyond being an evidentiary instrument operative in the VEA and MRCA claims processes. Its principal legal effect is to set, for decision-makers under the VEA and MRCA, the Repatriation Medical Authority’s opinion about what factors satisfy the necessary connection between Parkinson disease or Secondary Parkinsonism and relevant service on the balance of probabilities (s8, s9, s5). The operative duties and rights therefore arise from the parent statutes and administrative processes that use the Statement as authoritative medical guidance.

Right to rely on the Statement. Claimants have the right to have their claims assessed against the factors in the instrument where the claim is made under s120B VEA or s339 MRCA (s5). Where a claimant can demonstrate the existence of any factor listed in s9 and that it is related to the person’s relevant service (s10), decision-makers are required, in applying the VEA or MRCA, to have regard to this Statement as the Repatriation Medical Authority’s determination of the medical-scientific link on the balance of probabilities (s8). The Statement thereby functions as the primary medical opinion for those specified causal and aggravating pathways.

Duty to show the factor and service relationship. The claimant bears the evidentiary task of establishing that at least one listed factor existed and that it related to their relevant service. The Statement specifies threshold elements that must be demonstrated, such as timing windows, cumulative exposure hours, clinical or biochemical proof of intoxication, neuroimaging findings and minimum durations of medication exposure (s9; Schedule 1 definitions). For example, a claimant asserting manganese exposure must show a cumulative period of at least 500 hours within the relevant 10-year window prior to clinical worsening or onset (s9). A claimant relying on a cerebrovascular condition must provide neuroimaging showing white matter lesions, haemorrhage or infarction, where the factor requires it (s9).

Duty on medical evidence. Medical practitioners preparing opinions for claimants must provide records that link the clinical onset or clinical worsening to the factor relied upon and establish the temporal relation to service. The Statement specifies clinical definitions (for Parkinson disease and Secondary Parkinsonism) and evidentiary anchors such as neuroimaging, laboratory evidence of intoxication and clinical documentation of events such as subarachnoid haemorrhage or hypoxic cerebral insult, within specified windows (s7, s9, Schedule 1).

Administrative duty to consider other Statements. Decision-makers must follow the cross-reference rule in s11 where a factor refers to an injury or disease already the subject of another Statement of Principles. That requires locating the relevant other Statement and applying its terms, which can change the nature of the evidentiary inquiry and which medical factors are decisive.

Right to death coverage. The instrument expressly includes death from Parkinson disease and Secondary Parkinsonism where the disease or disorder contributed to the person’s terminal event or condition (s7 Death from Parkinson disease and Secondary Parkinsonism; Schedule 1 terminal event). Where a claimant for death benefits can show that PD or Secondary Parkinsonism contributed to the terminal event, the Statement provides the Authority’s position that such a causal link can be related to relevant service if a listed factor is present and related to the service (s7, s9, s10).

No express penalties or enforcement mechanisms. The Statement contains no provisions creating offences, pecuniary penalties or administrative fines. Enforcement occurs through the decision-making machinery of the VEA and MRCA where the Statement is applied, and through the normal review and appeal channels available under those Acts. The instrument is a medical determination; it gives the Repatriation Medical Authority’s view on probability and causation rather than prescriptive regulatory duties.

The Statement of Principles contains no enforcement provisions in the sense of criminal sanctions or civil fines. It is not framed as an instrument that imposes civil penalties or a compliance regime with sanctions. Instead, its enforcement mechanism is procedural and administrative: it provides the Repatriation Medical Authority’s medical-scientific opinion on the factors that, if established and related to relevant service, satisfy the balance-of-probabilities test for service connection under the VEA and MRCA (s8, s5). Application and effect therefore arise through the statutory decision-maker’s use of this Statement when determining entitlement under the parent Acts.

How decisions will be enforced or challenged. Because the Statement is an evidentiary standard for decision-makers under the VEA and MRCA, decisions that adopt or refuse application of the Statement’s factors will be subject to the review and appeal rights provided by those Acts and their administrative frameworks. The Statement itself does not set out appeal routes, but its role in the decision-making process means that incorrect application, procedural unfairness, or errors about whether a listed factor exists may be subject to administrative review or merits review as provided by the parent legislation and associated procedures. The instrument does not specify those procedures.

Administrative enforcement by decision-makers. Decision-makers within the Department of Veterans’ Affairs or MRCA processes will apply the Statement when deciding whether a claimant has established the required causal link to relevant service. The Statement therefore functions as the Authority’s medical rubric: where the decision-maker accepts that a listed factor exists and is related to service, the Authority’s opinion will support a finding of service connection on the balance of probabilities (s8, s9). Conversely, where the evidence does not establish any listed factor as related to relevant service, decision-makers may refuse to accept service connection on the basis of the Authority’s opinion.

No specified investigatory or compliance powers. The instrument contains no express investigatory powers for the Repatriation Medical Authority to compel evidence, nor does it create obligations on third parties to produce records. In practice, claimants will usually need to rely on medical records, employer records, imaging, laboratory tests and other documentary material to show the existence of listed factors, and decision-makers may request additional evidence in accordance with the procedures of the VEA and MRCA. Those procedural powers are outside this instrument and are governed by the parent Acts and departmental practice.

Transparent evidentiary anchors but potential for contested interpretation. The Statement sets out many specific, measurable anchors (timing windows, cumulative hours, laboratory evidence, imaging). Those anchors reduce interpretive uncertainty in many cases, but the decision to accept that an anchor has been met remains an administrative judgement applied to each claimant’s evidence. Where evidence is borderline, decision-makers and claimants may contest the sufficiency of the proof, invoking the review processes available under the VEA and MRCA frameworks.

This Statement operates as a specialised medical determination under s196B(3) of the VEA (s3 Authority), and it expressly applies to claims under s120B of the VEA and s339 of the MRCA (s5 Application). Its primary interactions with other laws are therefore procedural and evidentiary: the Statement is applied by decision-makers who must interpret and apply the VEA and MRCA in determining entitlement. The Statement does not itself change the statutory entitlement framework in those Acts; it informs the medical causation element within the statutory tests.

Cross-references to other Statements of Principles. Section 11 creates an explicit interface with other Statements of Principles: where a factor listed here refers to an injury or disease that is already the subject of another Statement determined under subsection 196B(3) of the VEA, then the factors in that other Statement apply according to its terms. That is an operational cross‑instrument rule which requires decision-makers to consult and apply other Statements where relevant. In practice this means that a claimant relying, for example, on a cerebrovascular accident or encephalitis that is itself the subject of another Statement may need to satisfy the evidentiary and temporal requirements of both instruments as they interact (s11).

Definitions linking to MRCA and VEA. The Schedule defines MRCA and VEA and the term relevant service in a manner that integrates this Statement with the eligibility concepts in those statutes. Relevant service is a gateway concept, and the Statement can be applied only if the person’s military service fits the Schedule definition (eligible war service, defence service excluding certain categories, or peacetime service under MRCA). The effect is that the instrument’s medical factors are only pertinent within the statutory categories of service in the parent Acts (Schedule 1 relevant service).

Evidentiary relationship to other medical or statutory tests. The Statement’s formulation of the Authority’s opinion that it is “more probable than not” that PD or Secondary Parkinsonism can be related to relevant service (s8) aligns with the civil standard of balance of probabilities. The parent Acts determine the legal test for service connection and entitlement; this Statement supplies the Authority’s medical view to be applied in that legal context. The Statement therefore interacts with statutory legal tests by providing a determinative medical input.

No displacement of statutory powers. The Statement does not purport to alter the powers or decision-making responsibilities granted by the VEA or MRCA. It does not create separate entitlement criteria nor does it modify the statutory benefits framework. Its role is to guide the medical causation assessment within those statutory processes.

Administrative procedures and records law. The Statement’s reliance on evidentiary anchors such as neuroimaging findings, laboratory evidence of intoxication and cumulative exposure hours means that other areas of law and practice,medical records law, privacy rules, and records disclosure procedures,will be relevant in practice. Decision-makers will need to obtain and rely on health records and possibly employer records; those processes occur under the parent Acts’ procedural frameworks and existing privacy and records regimes. The instrument does not amend or create privacy or disclosure powers, but it will interact with them in implementation.

Repeal interaction. The instrument repeals the 2016 Statement (s4). The practical interaction is that, as from commencement, the 2016 Statement will cease to be the operative medical input for claims in these categories. Decision-makers and claimants will therefore shift to the 2025 instrument’s factors and definitions when assessing causation questions after 24 November 2025 (s2, s4).

The Statement identifies itself as No. 88 of 2025 and is dated 24 October 2025. It commences on 24 November 2025 (s2 Commencement). It expressly repeals the previous Statement of Principles concerning Parkinson’s disease and secondary parkinsonism (No. 56 of 2016) (Federal Register of Legislation No. F2016L00570) which was made under subsections 196B(3) and (8) of the VEA (s4 Repeal). No other amendments or historical iterations appear within the text of this instrument.

Practical implications of the repeal. The repeal means that the 2016 Statement ceases to be current from the date of commencement. Decision-makers and claimants must, from that date, apply the 2025 Statement when considering whether Parkinson disease or Secondary Parkinsonism is related to relevant service for the purposes of the VEA and MRCA (s2, s4, s5). The instrument contains no transitional or savings provisions; it therefore operates from commencement as the operative Statement of Principles. Any transitional considerations (for example, whether claims lodged before commencement are to be assessed under the previous Statement) are not addressed in this instrument and would be subject to the statutory rules in the parent Acts or departmental policy.

Documented provenance. The Statement is signed on behalf of the Repatriation Medical Authority by the Chairperson, Professor Terence Campbell AM, and dated 24 October 2025. That establishes the instrument’s formal provenance within the Authority (front matter).

No internal amendment schedule. The instrument does not publish an internal schedule of future amendments or an expiry date. It is a permanent Statement until either repealed or replaced by a later instrument. Any future medical‑scientific developments that might prompt revision will be handled, as with the predecessor, by the Repatriation Medical Authority under subsection 196B(3) VEA, but those processes and timetables are not set out here.

No express saving for existing determinations. The instrument does not include express saving clauses or transitional provisions for determinations made under the 2016 Statement. The absence of such provisions in this instrument means that administrative practice and the VEA/MRCA framework will determine how existing matters are handled. The instrument’s repeal provision (s4) is categorical in its effect on the 2016 Statement; operational details of handling legacy matters will be a matter for decision-makers under the parent Acts and their procedural rules.

The instrument text itself contains no references to litigation, cases, judicial review decisions, or precedent. It does not cite any authorities or court determinations. The Statement is a medical-determinative instrument made by the Repatriation Medical Authority under its statutory powers. Any litigation that may arise from decisions that apply this Statement would be conducted under the review and appeal provisions of the VEA or MRCA and through administrative law channels, but no litigation history is recorded or cited in the Statement itself.

Consequently, there are no case names, reported judgments or judicial commentaries contained in or referenced by the instrument. For practitioners advising claimants, the absence of judicial guidance in the instrument means that precedential interpretation will be developed in separate proceedings, administrative reviews and appeals under the parent Acts; any such litigation developments will not be reflected in this instrument until and unless the Repatriation Medical Authority amends the Statement or a court establishes interpretive points through the statutory review processes.

Points likely to generate disputes. While the Statement itself contains no litigation history, it sets up factual and evidentiary thresholds that can be expected to generate contested decisions. Frequent contest points are likely to include the sufficiency and timing of evidence to meet cumulative exposure thresholds (for example the 500-hour rules for manganese and carbon disulphide), the sufficiency of neuroimaging to satisfy cerebral vessel disease requirements, the ascertainment and calculation of pack-years and regular smoking habit, the attribution of clinical worsening to specific medications and the documentary proof of inability to obtain appropriate clinical management. Administrative and judicial review cases that test those questions will create a litigation history over time, but that history is not contained in this instrument.

No binding judicial interpretations included. Because the Statement is an administrative medical determination and does not contain references to court decisions, it will be for courts and tribunals to interpret and apply its provisions where disputes reach them. Practitioners should therefore treat the instrument as the Authority’s current medical position while noting that its application and interpretation in contested cases will be shaped by decisions under the VEA and MRCA frameworks and administrative law principles.

The Statement contains numerous technical details and threshold conditions that create practical pitfalls for claimants, advisers and decision-makers. These are concrete interpretive and evidentiary "gotchas" grounded in the text.

1. Distinct definitions for Parkinson disease and Secondary Parkinsonism. The instrument defines Parkinson disease and Secondary Parkinsonism distinctly and excludes each from the other (s7(2)). A claimant must ensure the correct diagnostic label is used since different factors and timing windows apply. Mislabelling a condition can change which factors are available and the timing thresholds that must be satisfied.

2. Timing windows are tight and vary by factor and by whether the issue is onset or clinical worsening. Examples: for Parkinson disease a moderate to severe traumatic brain injury must have occurred at least 15 years before clinical onset to satisfy that factor, yet a moderate to severe TBI within 6 months before clinical worsening also qualifies for worsening (s9). For Secondary Parkinsonism a TBI within 6 months before clinical onset or worsening suffices. These variations are potentially determinative; obtaining accurate event and onset dates is essential.

3. Cumulative-hours thresholds for toxic exposures. The Statement requires cumulative exposure of at least 500 hours for manganese exposure and for carbon disulphide inhalation or cutaneous contact within specified 10-year windows (s9). Record-keeping gaps can be fatal to a claim. Employers’ rosters, industrial hygiene reports and witness statements may be necessary to establish cumulative hours. The Statement does not provide alternative presumptions or proxies for exposure.

4. Neuroimaging is a required evidentiary element for certain cerebral vessel diseases. Where a factor requires the presence of cerebral vessel disease, it must be accompanied by neuroimaging (MRI or CT) findings of cerebral white matter lesions, haemorrhage or infarction at the time of clinical worsening or onset (s9; Schedule 1 neuroimaging definition). The Schedule notes that neuroimaging is usually obtained at a date after clinical onset of disease. That can create evidentiary issues where early imaging was not performed; retrospective imaging may or may not be available.

5. Medication timing and cessation windows are precise and differ between onset and worsening and between PD and Secondary Parkinsonism. For example, development of Secondary Parkinsonism due to medication requires at least 14 days’ treatment and cessation of symptoms within 6 months of discontinuation (s9). For clinical worsening related to medication the PD provisions require at least 3 days’ treatment and cessation of worsening within 6 weeks of discontinuation. Claimants must document medication start and stop dates and symptom trajectories relative to cessation.

6. Definition of regular smoking habit and pack-year calculation. Schedule 1 defines regular smoking habit as at least 5 pack-years within a continuous 5-year period, and provides a conversion for non-cigarette tobacco where 1 gram equals one cigarette (Schedule 1 one pack-year). The Statement uses smoking cessation as a factor (for example, having not smoked for at least 5 years before clinical onset of Parkinson disease or not smoked within 10 years before clinical worsening), so the exact calculation method can be decisive (s9; Schedule 1). Partial or intermittent records of smoking will require careful reconstruction.

7. Cross-Statement dependencies can complicate proof. Section 11 requires application of other Statements where a factor refers to a disease covered elsewhere. Practitioners must therefore check for competing or complementary Statements that might impose additional evidentiary conditions or timing windows. Failure to consult other Statements risks incomplete proof.

8. The inclusion of inability to obtain appropriate clinical management as a factor. Both the Parkinson disease and Secondary Parkinsonism lists include inability to obtain appropriate clinical management before clinical worsening (s9). That is a potentially subjective factor that will require documentary proof of attempted access to care, waiting times, referral patterns and perhaps geographic or service-related barriers.

9. Repeal of the 2016 Statement without transitional provisions. The 2025 Statement repeals the 2016 instrument (s4), and the text contains no express transitional arrangements. Practitioners should check the parent legislation and departmental policy about how claims existing before commencement will be treated.

10. Terminal event definition for death claims. The Statement includes death where PD or Secondary Parkinsonism contributed to the terminal event, and defines terminal event to include examples such as pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (s7; Schedule 1 terminal event). When preparing death claims, advisers must show contribution to the terminal event and connect it to a listed factor related to relevant service.

11. Narrowly specified toxic agents. The Schedule lists named organophosphorus esters and a specified list of medications. Causation claims based on exposures not specifically named must be mapped carefully to the instrument’s definitions. For organophosphorus esters the instrument lists specific agents, which constrains reliance on unnamed chemicals (Schedule 1 organophosphorus ester).

12. Proof of intoxication requires clinical, haematological or biochemical evidence. For methanol/ethylene glycol, cyanide and manganese intoxication the Statement requires clinical, haematological or biochemical evidence of intoxication within specified windows (s9). Mere exposure without objective evidence of intoxication is insufficient.

13. Burden of proof remains balance of probabilities, but the Authority’s list is exhaustive for the factors it chooses to recognise. Section 8 states the Authority’s view that, on the balance of probabilities, PD or Secondary Parkinsonism can be related to relevant service. Practitioners should remember that the Statement lists the factors the Authority accepts as sufficient; absence of a listed factor does not itself preclude other medical evidence, but decision-makers will apply the Statement as the authoritative position of the Authority for these pathways.

For claimants and advisers preparing a VEA or MRCA claim that seeks to rely on this Statement, compliance means assembling evidence that maps precisely to the instrument’s defined factors, timing windows, and definitions. The following steps are concrete and are grounded in the Statement’s provisions.

1. Establish relevant service. Confirm that the claimant’s service fits the Schedule definition of relevant service: 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 MRCA (Schedule 1 relevant service). The Statement applies only to claims that fall under s120B VEA or s339 MRCA (s5).

2. Verify the diagnosis and label the condition correctly. Obtain current and historical neurology records that document the diagnosis as Parkinson disease or Secondary Parkinsonism per the clinical criteria in s7(2). Ensure the diagnosis aligns with the instrument’s definitions, and that exclusions listed in the definitions (for example Parkinson Plus diseases, other primary neurodegenerative diseases) are addressed in the clinical material.

3. Determine whether the claim concerns onset or clinical worsening. The Statement’s factors are split between initial clinical onset and clinical worsening. The temporal thresholds and required proof differ accordingly (s9). Document clinical onset dates and dates of any worsening events. Obtain clinician notes, movement disorder assessments, UPDRS or other objective measures where available, to anchor onset and worsening dates.

4. Map the claimed factor to the precise wording in s9. Identify which specific factor in s9 is being relied upon. The Statement accepts any one factor as sufficient on the balance of probabilities. For example, if relying on a traumatic brain injury, determine whether the injury meets the severity descriptor “moderate to severe” and whether it occurred within the specific time window relevant to onset or worsening (s9).

5. Collect objective medical evidence required by the Statement. Where the factor requires neuroimaging findings, obtain MRI or CT reports showing white matter lesions, haemorrhage or infarction contemporaneous with onset or worsening (s9; Schedule 1 neuroimaging). For intoxications (methanol, ethylene glycol, cyanide, manganese), obtain laboratory, clinical or biochemical evidence showing intoxication within the required time window. For neurosyphilis or HIV, produce serological or diagnostic documentation. For hypoxic cerebral insult, supply records (for example cardiac arrest notes, CO exposure reports) that establish the event within the stated time frame (Schedule 1 hypoxic cerebral insult).

6. Demonstrate exposure histories with documentary support. For cumulative exposures like manganese or carbon disulphide (500 cumulative hours within 10 years), collect employer records, rosters, training logs, occupational health reports, pay records and witness statements that allow calculation of cumulative hours. For organophosphorus ester exposures with acute cholinergic poisoning, demonstrate the acute symptom set within 24 hours of exposure and identify the agent where possible (s9; Schedule 1 acute cholinergic poisoning and organophosphorus ester).

7. Establish smoking histories precisely. Where the factor relies on a regular smoking habit and cessation intervals (for example not smoked for at least five years before clinical onset), compile a smoking history with dates, quantities, and conversions to pack-years using the Schedule’s definitions (Schedule 1 regular smoking habit and one pack-year). Where non-cigarette tobacco was used, apply the Schedule’s grams conversion.

8. Document medication exposures with start/stop dates and symptom trajectory. For claims based on medication-associated onset or worsening, produce pharmacy records, prescription charts, inpatient medication charts and treating clinician letters showing start date, dose, duration, cessation date, the minimum exposure duration required by the Statement, and clinical notes documenting whether symptoms ceased within the specified period after discontinuation (s9; Schedule 1 specified list of medications). Pay attention to the different minimum exposure durations and cessation windows for Secondary Parkinsonism (e.g. 14 days treatment and cessation within 6 months) versus clinical worsening (3 days treatment and cessation within 6 weeks).

9. Gather neuroimaging and neuropathology where available. For Parkinson disease the definition includes pathological hallmarks such as alpha-synuclein-associated Lewy bodies, and a sustained response to levodopa is noted (s7). While neuropathology is not commonly available in life, where it exists it will be strong evidence. Neuroimaging for vascular factors is an explicit requirement in many factors (s9; Schedule 1 neuroimaging).

10. Prove inability to obtain appropriate clinical management where relied upon. If inability to obtain appropriate clinical management before clinical worsening is being used as a factor, produce referral records, appointment logs, correspondence showing waiting times, evidence of service unavailability or documented failed attempts to secure appropriate care (s9).

11. Check cross-Statement dependencies. If a factor refers to another disease that has its own Statement of Principles, obtain and apply the other Statement’s requirements as required by s11. For example, if a factor refers to a cerebrovascular accident and that injury is the subject of another Statement, the terms of that Statement will apply in relation to proving that factor.

12. Prepare expert medical evidence that links factor to condition and service. Obtain treating clinicians’ and independent medical specialists’ opinions that explicitly address whether the listed factor existed, whether it meets the Statement’s definition and temporal requirements, and whether the factor is related to the claimant’s relevant service. The Authority’s position is that the factors listed satisfy the balance of probabilities when present; practitioners must therefore use clinical expertise to map the claim facts to the Statement.

13. Record-keeping and timing. Ensure that claims lodged after the commencement date (24 November 2025) are supported by evidence mapped to the 2025 Statement (s2, s5). For claims initiated before commencement, check departmental guidance and the VEA/MRCA rules about transitional treatment, because the instrument itself does not include transitional clauses (s4 Repeal).

14. Anticipate evidentiary gaps and mitigate them. Where historical imaging or laboratory evidence is absent, consider whether later imaging or clinical assessments can fill evidentiary gaps and whether secondary evidence (for example contemporaneous hospital discharge summaries, occupational health records, or eyewitness statements) can corroborate exposure histories. The Schedule notes that neuroimaging is usually obtained after clinical onset; practitioners should therefore seek all available contemporaneous medical records and, where reasonable, arrange current investigations that may assist in establishing the condition and its likely antecedents.

15. Prepare for review and appeal. Since the Statement is an authoritative medical view used in statutory decision-making, prepare to engage with the VEA and MRCA administrative review processes if a decision does not accept the evidence. Document all evidence and expert opinions clearly, aligning each piece of evidence to the specific textual requirement in s9 and the Schedule definitions.

Following these steps will align a claim closely to the Statement’s textual requirements. The Statement’s specificity reduces uncertainty about what the Repatriation Medical Authority regards as acceptable medical‑scientific factors, but it increases the evidentiary burden on claimants to produce precisely targeted, time‑anchored documentation that maps to the instrument’s definitions and thresholds.