Statement of Principles concerning personality disorder (Reasonable Hypothesis) (No. 17 of 2018)

This SOP revolves around three principal legal‑technical concepts: the statutory role of a Statement of Principles, the clinical definition and boundaries of "personality disorder" used for claims, and the discrete list of causal "factors" that create the minimum evidentiary base for a reasonable hypothesis linking the condition to relevant service.

1. Role of a Statement of Principles. The SOP is made under s 196B(2) of the VEA (s 3) and therefore functions as a medical‑scientific determination that decision‑makers use to test whether a claimant has raised a reasonable hypothesis connecting their condition to service. The instrument’s text repeatedly frames its material as being "about" personality disorder and death from personality disorder (s 7(1)), and states the Repatriation Medical Authority’s view that there is sound medical‑scientific evidence that personality disorder and death from personality disorder can be related to relevant service (s 8). That statement is the authority’s explanatory premise; the operative text sets the precise diagnostic and causal criteria used to operationalise that premise.

2. Definition of personality disorder. The SOP imports DSM‑5 diagnostic criteria verbatim-style (s 7(2)): enduring pattern of inner experience and behaviour deviating markedly from cultural expectations; manifested in two or more of cognition, affectivity, interpersonal functioning or impulse control; inflexible and pervasive; leads to clinically significant distress or impairment; stable with onset traceable to adolescence or early adulthood; not better explained by another mental disorder; not attributable to substance or another medical condition. The definition includes the standard DSM‑5 enumerated personality disorders and explicitly excludes "personality change due to another medical condition" (s 7(2) Notes; Schedule 1). The instrument also notes the ICD‑10‑AM codes that typically correspond to personality disorder (s 7(3)-(4)) but states that the meaning for purposes of the SOP is the DSM‑5‑derived definition (s 7(3)).

3. Factors that must exist. The SOP identifies a discrete list of factors which, if present, "must as a minimum exist" for a reasonable hypothesis to be raised (s 9). These factors are time‑limited and context‑specific. Key elements include:

   • Exposure to a category 1A stressor within two years before clinical onset (s 9(1)), or within two years before clinical worsening (s 9(5)). Category 1A stressor is defined as life‑threatening events, serious physical attack or assault (including rape and sexual molestation), or being threatened with a weapon/held captive/kidnapped/tortured (Schedule 1).
   • Exposure to a category 1B stressor within one year before onset (s 9(2)) or within one year before worsening (s 9(6)). Category 1B stressors are discrete events such as killing or maiming a person, witnessing killings or critical injuries, witnessing atrocities, participation in clearance of corpses, or viewing corpses/critically injured casualties as an eyewitness (Schedule 1). The instrument's endnotes record an amendment to the category 1B stressor definition (Endnote 3-4).
   • Severe childhood abuse before onset or worsening (s 9(3), (7)), defined to require serious harm or neglect while under 16, perpetrated by a parent, care provider or other adult in contact with the child (Schedule 1).
   • Presence of a "clinically significant disorder of mental health as specified" within five years before clinical onset or worsening (s 9(4), (8)), with the Schedule listing an extensive set of conditions (for example, PTSD, bipolar disorder, substance use disorder, schizophrenia, depressive disorder etc.). The Schedule expressly states that "warrant ongoing management" does not require that any treatment was actually given (Schedule 1 note).
   • Inability to obtain appropriate clinical management for personality disorder (s 9(9)).

4. Relationship to service and aggravation. The instrument emphasises that factors must be related to the person's relevant service (s 10(1)). It also makes a temporal‑causal distinction for aggravation and material contribution: subsections 9(5)-(9) apply only where the personality disorder was suffered or contracted before or during the service and did not arise out of service , in other words, they operate to address material contribution or aggravation rather than primary causation (s 10(2)). This is a mechanical rule about the proper use of certain factors in aggravation cases.

5. Cross‑references to other SOPs. Where a factor in s 9 refers to another injury or disease for which an SOP exists, that other SOP’s factors apply in accordance with their own terms (s 11). This is an interlocking mechanism intended to reconcile overlapping symptom constellations and comorbid pathology across SOP instruments.

Those are the core concepts. The Schedule provides the definitional scaffolding for implementation, including precise lists, exclusions (for example, corpse excludes seeing a closed body bag or viewing a body in an open‑casket coffin), and the taxonomy of relevant service (operational/peacekeeping/hazardous/British nuclear test defence under VEA; warlike/non‑warlike under MRCA).

The instrument is a technical tool that affects claimants, their advisers, and the administrative decision‑makers who assess claims under the VEA and MRCA. The text identifies the scope of its application at s 5: it "applies to a claim to which section 120A of the VEA or section 338 of the MRCA applies." Those references tie the SOP to statutory decision pathways , the instrument itself does not create entitlements but defines the medical‑scientific basis used within entitlement assessments. Consequently, the practical effect reaches the following groups:

• Claimants: veterans, members of Peacekeeping Forces, and members of the Forces (as classified in the Schedule’s definition of relevant service) who assert that personality disorder, or death from personality disorder, is connected to their relevant service. For a claimant to raise a "reasonable hypothesis" under the linked statutory provisions, at least one factor listed in s 9 must exist and be related to the relevant service (s 9; s 10(1)).

• Medical experts and treating clinicians: the SOP makes DSM‑5 diagnostic criteria the definitional baseline (s 7(2)). A clinician preparing a report to support a claim must therefore diagnose personality disorder according to the DSM‑5 criteria set out in s 7(2), and address timing of onset/worsening, the presence of any listed clinically significant mental disorders in the five years before onset/worsening, history of the specified stressors within the relevant windows, and whether the person was unable to obtain appropriate clinical management (s 7; s 9; Schedule 1).

• Administrative decision‑makers and advisers: the SOP is intended to be applied by decision‑makers who determine whether a reasonable hypothesis exists for causation in claims under the specified statutory provisions. The instrument changes the evidentiary map that those decision‑makers use: it lists the minimum factors and defines terms such as category 1A and 1B stressors, severe childhood abuse, clinically significant disorder, corporeal definitions and what constitutes relevant service (ss 5, 9, Schedule 1). Decision‑makers must evaluate whether the evidence establishes at least one of the enumerated factors and whether that factor is related to the person’s relevant service (s 10(1)).

• Related SOPs and medical‑evidentiary regimes: where a factor in s 9 invokes an injury or disease covered by another SOP, the other SOP applies "in accordance with the terms of that Statement of Principles as in force from time to time" (s 11). This means claimants and decision‑makers dealing with comorbidity , say, PTSD or traumatic brain injury referenced in s 9 via clinically significant disorders or stressor definitions , must incorporate those other SOPs into the causation analysis.

The instrument does not itself authorise or require payments; it operates as an element used in the statutory determination process under the VEA and MRCA. The text therefore affects the flow and content of evidence that claimants must present and the criteria decision‑makers use, but contains no provisions on procedural remedies, review mechanisms, or the mechanics of benefits administration.

This SOP is primarily prescriptive of diagnostic and causal criteria rather than proscriptive of behaviour or offences. It does not create civil or criminal penalties, nor does it specify procedural rights in the benefit system; its legal effect is to impose a duty on decision‑makers and clinicians to use the SOP’s medical criteria when testing whether a reasonable hypothesis exists connecting personality disorder (or death from personality disorder) with relevant service in claims governed by s 120A of the VEA or s 338 of the MRCA (s 5). The principal duties and rights arising from the instrument are as follows:

Duties (implicit and operational)

• Duty to apply the SOP in relevant claims. Where a claim falls within the statutory references (s 5), decision‑makers must consider the SOP’s factors and definitions when assessing whether a reasonable hypothesis exists. The instrument itself does not spell out administrative steps, but it is a binding technical determination made under s 196B(2) of the VEA (s 3), and will therefore be used in the statutory causation analysis (s 8 sets out the Authority's view on evidence).
• Duty to adopt the DSM‑5‑derived diagnostic criteria when diagnosing personality disorder for the purposes of the SOP. Subsection 7(2) supplies the diagnostic criteria that must be used in applying the SOP. Medical evidence prepared for claims should address those criteria, including onset, pervasiveness, impairment, and exclusions such as personality change due to another medical condition.
• Duty to consider timing and temporal windows. The factors in s 9 contain precise time windows (for example, category 1A stressor within two years before clinical onset (s 9(1)); category 1B within one year (s 9(2)); clinically significant disorders within five years (s 9(4))). Decision‑makers and clinicians must therefore gather and assess evidence with those temporal parameters in mind.
• Duty to examine relationship to relevant service. Subsection 10(1) requires that any factor relied upon "must be related to the relevant service rendered by the person." That introduces a factual nexus inquiry into the adjudicative process; decision‑makers must determine whether the identified factor can be connected to the claimant’s relevant service type (defined in Schedule 1).

Rights (operational and evidentiary)

• Right for a claimant to have the SOP applied in their causation assessment. Where a claim invokes the specified statutory sections, the SOP supplies the baseline medical criteria that must be used; claimants are entitled to have the decision‑maker apply those criteria rather than some other standard.
• Right to rely on the enumerated factors as a minimum evidentiary threshold for a reasonable hypothesis. The SOP clearly states that "At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised" (s 9). If a claimant can establish one of these factors and link it to their relevant service, they have met the SOP’s minimal medical basis for a reasonable hypothesis.
• Evidentiary clarifications that expand or limit proof. The Schedule clarifies that management can be justified by the need for regular visits (for example at least monthly) and that "to warrant ongoing management" does not require actual treatment to have been received (Schedule 1 notes). This affects evidentiary strategies: absence of treatment is not automatically fatal where the clinical condition would have warranted ongoing management.

Limitations and boundaries

• No obligation on medical practitioners to provide care is created by the SOP; “inability to obtain appropriate clinical management” operates as an evidentiary factor for causation rather than as a direct legal entitlement to treatment (s 9(9)).
• The SOP excludes "personality change due to another medical condition" from the definition of personality disorder for the purposes of this instrument (s 7(2) Note 2; Schedule 1). Therefore, if the disorder is attributable to another medical condition, the SOP does not apply to that presentation.
• Where a factor in s 9 refers to another injury or disease covered by an existing SOP, the other SOP’s factors govern that part of the causation analysis (s 11). This creates an obligation to cross‑apply other SOPs in cases of overlap.

In summary, the SOP imposes technical duties on clinicians and decision‑makers to use its DSM‑5‑based definition and its enumerated factors when assessing causation, and creates corresponding rights for claimants to have their claims judged by those criteria. It does not create new monetary or procedural rights itself; rather it shapes the medical causation step within existing statutory claim pathways.

The text of the Statement of Principles contains no provisions imposing criminal liability, civil penalties, administrative fines, or a dedicated enforcement mechanism. It is a medical‑scientific determination made under subsection 196B(2) of the VEA (s 3) and functions as an evidentiary instrument in the administration of claims under the VEA and MRCA (s 5). Its enforcement, therefore, is indirect and administrative rather than penal.

How it is enforced in practice (as implied by the instrument)

• Administrative application by decision‑makers. The practical "enforcement" is carried out by the administrative decision‑makers responsible for adjudicating claims under the statutory provisions referenced (s 5). Those decision‑makers will use the SOP as the technical benchmark to assess whether a "reasonable hypothesis" has been raised connecting personality disorder or death from personality disorder to relevant service. The SOP supplies the medical criteria and the factors which must be evaluated and does not itself prescribe sanctions for non‑compliance by parties.
• Evidentiary weight in determinations. The SOP is intended to carry significant evidentiary weight in determining causation. If decision‑makers follow statutory processes that refer to SOPs for causation testing, refusal to apply the SOP in a relevant claim could be the subject of administrative review or judicial scrutiny under the general administrative law and merits‑review mechanisms that apply to the decision‑makers’ statutory scheme. The instrument itself does not set those review pathways; it simply establishes the medical content used in the decision process.

No penalty provisions in the instrument

• The instrument contains no enforcement provisions, no specification of sanctions against practitioners, claimants or decision‑makers who fail to provide or use evidence in particular ways, and no registration or reporting obligations beyond the definitional and causal criteria set out in the operative sections and Schedule. The endnotes record the instrument's amendment history and revocation of a prior SOP, but they do not record enforcement steps (Endnote 3-4).

Implementation and administrative enforcement risks

• Because enforcement is essentially the application of the SOP by decision‑makers, implementation risk lies in the consistency and correctness with which decision‑makers and clinicians interpret and apply the defined terms, temporal windows and causal link requirements (ss 7, 9, 10). Errors in application can be remediable through whatever statutory review or merits review regimes govern the decision‑maker, but any challenge would be to the decision that applied or failed to apply the SOP properly rather than to the SOP instrument itself.

In short, the instrument provides the clinical and causal rules that decision‑makers must apply; it does not itself create penalties or a direct enforcement apparatus. Its practical enforcement is administrative, through its incorporation into the statutory decision processes under the VEA and MRCA.

The Statement explicitly situates itself within the VEA and MRCA statutory frameworks and cross‑links to other Statements of Principles. Its interactions fall into three categories: statutory embedding, cross‑SOP linkages, and classification/adaptation interactions with diagnostic taxonomies (DSM‑5 and ICD‑10‑AM).

1. Statutory embedding (VEA and MRCA)

• The SOP is made under subsection 196B(2) of the VEA (s 3). It applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (s 5). Those references integrate the SOP into the statutory causation test used in entitlement decisions. The instrument does not reproduce the statutory texts of s 120A or s 338; rather it declares the SOP’s applicability to claims under those provisions.
• The Schedule defines "relevant service" in terms of the service categories used in the VEA and MRCA: operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike/non‑warlike service under the MRCA (Schedule 1). This ties the SOP’s causal nexus enquiries to the statutory classifications of service exposure.

2. Cross‑SOP interaction

• Section 11 creates a mechanism for interoperability between SOP instruments: when a factor in s 9 refers to an injury or disease for which another SOP has been determined under s 196B(2) of the VEA, the other SOP’s factors apply "in accordance with the terms of that Statement of Principles as in force from time to time" (s 11). This is a formal cross‑reference rule that compels decision‑makers to apply the contemporaneous text of other SOPs where overlap occurs.
• Practically, this means comorbid or causally linked conditions , for example PTSD or traumatic brain injury listed in the Schedule as clinically significant disorders , will bring their own SOP factors into play. The causation analysis thus becomes a composite of SOPs where appropriate.

3. Diagnostic taxonomy interaction (DSM‑5 and ICD‑10‑AM)

• The SOP bases the meaning of personality disorder on DSM‑5 diagnostic criteria (s 7(2); Schedule 1 definition of DSM‑5). The Schedule also lists ICD‑10‑AM codes commonly used for personality disorder (s 7(3)-(4)) but makes clear that in applying this SOP the meaning is that given in subsection 7(2). The instrument therefore selects DSM‑5 as the interpretive baseline for diagnostic meaning, while retaining ICD‑10‑AM codes as nominal identifiers (s 7(3)-(4)).
• The exclusion of "personality change due to another medical condition" (s 7(2) Note 2; Schedule 1) imports another DSM‑5 construct and thereby interacts with the operation of medical opinions that might attribute the disorder to neurological or medical causes.

4. Interaction with amended SOPs and subsequent modifications

• The endnotes record that this SOP was compiled and that an amendment determination , Veterans' Entitlements (Statements of Principles,Category 1B Stressor) Amendment Determination 2018 (No. 87 of 2018) , amended the category 1B stressor definition and added or adjusted the corpse definition (Endnotes 3-4). The SOP therefore interacts with later Amendment Determinations and must be read as modified where those amendments have commenced (Endnote 3). The instrument itself refers to "as in force from time to time" in s 11, signalling intended dynamism in cross‑SOP application.
• Where a factor references an injury or disease covered by another SOP, the terms of that SOP govern how to treat that factor (s 11). That mechanism reduces the risk of inconsistent medical thresholds across SOPs, while creating an administrative requirement to identify and apply contemporaneous versions of other SOPs.

5. Procedural and administrative law interaction

• The SOP does not, by its text, create or displace statutory review or internal reconsideration rights. However, because it functions as a determinative medical instrument used within statutory entitlement decision processes, it will be engaged in administrative law and merits review processes that challenge application of the SOP in specific decisions. The instrument itself contains no procedural text about review or remedies.

In summary, this SOP is embedded in the VEA/MRCA causation architecture, must be read alongside other SOPs where overlap exists, uses DSM‑5 as the diagnostic anchor while noting ICD‑10‑AM codes, and is subject to amendment determinations that may change its definitional content. Decision‑makers and advisers must therefore apply it in the context of the statutory provisions it references and the contemporaneous SOP corpus.

The compilation includes the primary instrument and its amendment history as recorded in the endnotes. Key amendment and legislative history points visible in the instrument are:

• Original registration and commencement: The Statement of Principles concerning personality disorder (Reasonable Hypothesis) (No. 17 of 2018) was registered on 6 March 2018 and commenced on 2 April 2018 (Endnote 3; s 2). The instrument is a Determination of the Repatriation Medical Authority made under s 196B(2) of the VEA (s 3).

• Revocation of earlier SOP: The instrument revokes the prior Statement of Principles concerning personality disorder No. 70 of 2008, as amended, which had been made under subsections 196B(2) and (8) of the VEA (s 4). This is an express replacement of the previous SOP text by the No. 17 of 2018 SOP.

• Amendment Determination No. 87 of 2018: The compilation notes that it "Includes amendments up to: Veterans' Entitlements (Statements of Principles,Category 1B Stressor) Amendment Determination 2018 (No. 87 of 2018) (F2018L01188)." The day of commencement of that Amendment Determination is listed as 24 September 2018 (top matter). Endnote 3 records registration of that amendment on 28 August 2018 with commencement 24 September 2018. Endnote 4 specifies how provisions were affected: Schedule 1 - Dictionary - category 1B stressor was repealed and substituted (rs. No. 87 of 2018) and Schedule 1 - Dictionary - corpse was added (ad. No. 87 of 2018) (Endnote 4). The compiled text appears to reflect those changes in the Schedule (the category 1B stressor list and the corpse definition are present).

• Compilation date: The compilation date at the head of the instrument is 24 September 2018, and it states that it shows the text of the law as amended and in force on that date (Compilation No. 1). The endnotes caution that uncommenced amendments are not shown in the compiled text and that further amendment detail is available on the Legislation Register (front matter).

• Amendments to other SOPs and ongoing modification: The instrument’s s 11 anticipates that other Statements of Principles exist and may change "from time to time"; where factors refer to injury or disease covered by another SOP, those SOPs "apply in accordance with the terms of that Statement of Principles as in force from time to time" (s 11). This signals that subsequent amendment determinations to other SOPs will affect how s 9 factors that refer to other injuries are applied.

The endnotes and the instrument itself do not record further amendments beyond No. 87 of 2018 in the compiled text. The compilation notes the possibility of uncommenced amendments and indicates where to find the most up‑to‑date texts on the Legislation Register. Practitioners should consult the Legislation Register or RMA notice pages for any later Determinations or Amendment Determinations that post‑date the 24 September 2018 compilation.

The compiled text of this Statement of Principles contains no litigation history, and there are no judicial decisions recorded in the instrument or its endnotes. The document is a statutory determination of the Repatriation Medical Authority made pursuant to s 196B(2) of the VEA (s 3) and is presented as a technical medical‑scientific statement intended for administrative application. The endnotes provide legislative history and amendment history (Endnotes 3-4) but do not record any case law, judicial interpretation, or challenges to the instrument itself.

What the instrument does reveal about likely areas of contention (evidentiary and interpretive) that commonly generate litigation or administrative review in analogous contexts

• Definition and application of "clinical onset" and "clinical worsening": The SOP’s causal factors are tied to the timing of "clinical onset" and "clinical worsening" (s 9(1)-(2), (5)-(6)). Disputes may arise over when onset or worsening occurred for a particular claimant and which temporal window applies. The SOP places discrete time limits on when certain stressors must have occurred in relation to onset/worsening, producing potential evidentiary disputes about timing.
• Meaning and proof of stressors: The SOP defines category 1A and 1B stressors (Schedule 1). Evidence establishing those stressors , for example whether an event constitutes a "life‑threatening event" or whether an eyewitness actual saw a corpse as opposed to exposure through media , may be contested. The Schedule excludes exposure via public broadcasting and mass media from "eyewitness" (Schedule 1), which may affect claims where the claimant’s recollection is derived from third‑party reporting.
• Severe childhood abuse and perpetrator relationship: The Schedule requires severe harm or neglect while under 16 perpetrated by specific adults "in contact with that child" (Schedule 1). Disputes may occur over the identity and relationship of the alleged perpetrator, timing, and whether the harm meets the threshold of "serious."
• Inability to obtain appropriate clinical management: The phrase in s 9(9) invites factual disputes about what constitutes "appropriate" management and what evidence suffices to show inability to obtain it. The Schedule’s note that "warrant ongoing management" does not require actual management to have been received is helpful for claimants but leaves room for debate about the meaning of appropriate management.
• Comorbidity and cross‑SOP application: Section 11 requires application of other SOPs where a s 9 factor refers to another injury or disease. Litigation or review may follow where parties disagree about which SOP applies or how multiple SOPs interact.

Because the instrument is an administrative, medical framework used in statutory decisions, most potential legal challenges are likely to be administrative law or merits review proceedings challenging how a decision‑maker applied the SOP to the facts. The instrument itself contains no litigative record, and practitioners should check administrative tribunal and court databases for any decisions that have considered this SOP since its compilation date.

The instrument contains several features and drafting choices that create specific evidentiary, interpretive, and administrative risks for claimants, treating clinicians and decision‑makers. Below are concrete "gotchas" drawn from the text that advisers should note and plan for when preparing or assessing claims:

1. Time windows are strict and vary by factor. The SOP requires particular time proximities between stressors and clinical onset/worsening: for category 1A stressors the window is two years before clinical onset or worsening (s 9(1), (5)); for category 1B stressors the window is one year before onset or worsening (s 9(2), (6)); for a clinically significant disorder the window is five years before onset or worsening (s 9(4), (8)). If documentary or medical evidence places a stressor outside the specified window, the SOP says that factor cannot be used to raise a reasonable hypothesis , absent other qualifying factors. Practically, clinicians must date onset/worsening and stressor exposure with care.

2. DSM‑5 is the diagnostic anchor, not ICD codes. Although the SOP lists ICD‑10‑AM codes (s 7(3)-(4)), it makes clear that the meaning of personality disorder "is that given in subsection (2)" , i.e., the DSM‑5 rendition (s 7(3)). A clinician relying solely on an ICD code without addressing DSM‑5 criteria risks leaving the SOP unengaged in evidence.

3. "Death from personality disorder" requires contribution to a terminal event. The SOP defines death from personality disorder to include death from a terminal event "that was contributed to by the person's personality disorder" (s 7(5)). Practically, that requires medical evidence establishing that the personality disorder contributed to, for example, respiratory failure or cardiac arrest (Schedule 1 terminal event list). Mere presence of personality disorder at death is insufficient; a causal link to the terminal event must be shown.

4. "Personality change due to another medical condition" is excluded. The SOP excludes personality change due to another medical condition (s 7(2) Note 2; Schedule 1). Where a respondent’s presentation is better explained neurologically (for example frontal lobe lesion), the SOP’s personality disorder definition does not apply. Advisers should ensure differential diagnoses are addressed.

5. Eyewitness and media exposure distinction. The Schedule defines "eyewitness" as someone who experiences an incident first hand and expressly excludes persons exposed only to public broadcasting or mass media coverage (Schedule 1). Claimants who rely on media exposure rather than being first‑hand eyewitnesses will not meet the eyewitness aspect of category 1B stressors.

6. Corpse definition is narrow. The Schedule defines "corpse" as human remains/body parts of persons who have met a violent or horrific death and excludes seeing a closed body bag or viewing a body in an open‑casket coffin (Schedule 1). Exposure to a closed body bag or a closed coffin is excluded from the "corpse" concept for the purposes of category 1B. The instrument was amended to add or alter the corpse definition (Endnotes 3-4), so practitioners should confirm which version applies.

7. Severe childhood abuse requires specific perpetrator relationships. The Schedule requires that severe childhood abuse be perpetrated by a parent, care provider, adult who works with or around that child, or any other adult in contact with the child (Schedule 1). Abuse by peers, for example, is not included unless the perpetrator falls within the enumerated categories.

8. "Clinically significant disorder" list and management note. The Schedule lists specific conditions that qualify as clinically significant disorders (Schedule 1). Note 1 to that definition indicates that "management" may involve regular visits (for example at least monthly) to mental health professionals. Note 2 clarifies that "to warrant ongoing management" does not require that actual management was received. That helps claimants who could not access treatment but whose condition would have warranted ongoing management. However, the practical difficulty is establishing that the condition existed and would have warranted such management, even in the absence of treatment records.

9. "Inability to obtain appropriate clinical management" is vague. Section 9(9) provides a factor, but the instrument does not define "appropriate" or specify how inability is demonstrated. That invites evidentiary disputes about whether the claimant sought care, what avenues were available, and whether those avenues were appropriate. Where treatment is available but not accessed, this factor may be hard to establish.

10. Application to aggravation vs primary causation. Sections 9(5)-(9) are limited by s 10(2) to cases of material contribution to, or aggravation of, personality disorder where the disorder pre‑existed or was contracted before/during service but did not arise out of service. This mechanical rule means that factors addressing clinical worsening or inability to get management cannot be used to establish primary causation for new‑onset personality disorder that arose out of service.

11. Cross‑SOP complexity. Section 11 requires applying other SOPs where factors refer to injuries or diseases covered by those SOPs. This can create complexity: claimants with comorbidity will need expert reports that map multiple SOPs concurrently and reconcile their time frames and factors.

12. Revocation of prior SOPs and amendment dates. The instrument revokes SOP No. 70 of 2008 (s 4) and records subsequent amendments (Endnotes). Advisers must ensure they are applying the correct, current SOP version and any Amendment Determinations that have commenced, as definitions such as category 1B stressor were amended by Determination No. 87 of 2018.

In short, the principal gotchas are timing windows, DSM‑5 diagnostic anchoring, narrow definitions of stressor terms (eyewitness, corpse), the exclusion of personality change due to other medical conditions, and the evidentiary vagueness around "inability to obtain appropriate clinical management." Practitioners must address these head‑on in medico‑legal reports and documentary evidence.

For claimants, treating clinicians, medico‑legal advisers and decision‑makers, compliance with the SOP requires producing and evaluating evidence in the precise terms the instrument sets out. The steps below translate the SOP’s operative text into actionable evidence and reporting priorities.

1. Establish the DSM‑5 diagnosis and date clinical onset/worsening

• Clinician report must apply the DSM‑5 criteria as stated in subsection 7(2): show how the individual's enduring pattern meets the listed criteria (cognition, affectivity, interpersonal functioning, impulse control), evidence of inflexibility and pervasiveness, demonstration of clinically significant distress or impairment, stability and traceability to adolescence or early adulthood, and the exclusion of other mental disorders or attributable physiological causes. If personality change due to another medical condition is a possibility, provide differential diagnostic material and imaging or neurological evidence as required (s 7(2); Schedule 1).
• Precisely date clinical onset and any clinically significant worsening. The SOP’s time windows (s 9) hinge on these dates. Reports should explain the evidential basis for the onset/worsening dates (medical notes, symptom history, treating records, contemporaneous statements).

2. Demonstrate at least one s 9 factor and link it to relevant service

• Identify which s 9 factor(s) are claimed. Prepare targeted evidence for the factor:

  • Category 1A stressor (s 9(1)/(5)) , show that the event meets one of the Schedule’s elements (life‑threatening event, serious assault including rape, or being threatened with a weapon/held captive/kidnapped/tortured) and that it occurred within two years before the clinical onset or worsening. Service records, incident reports, contemporaneous clinical notes, unit diaries, and witness statements can be used.
  • Category 1B stressor (s 9(2)/(6)) , show event meets the Schedule list (killing/maiming, eyewitness to killing/critical injury/atrocities, clearance/ viewing of corpses) and occurred within one year before onset/worsening. Ensure eyewitness status is evidenced by presence on‑site or authoritative reporting; media exposure is excluded (Schedule 1).
  • Severe childhood abuse (s 9(3)/(7)) , gather evidence supporting the nature (serious physical, emotional, psychological or sexual harm or neglect), timing (under 16), and perpetrator relationship (parent, care provider, adult who works with/around the child or any other adult in contact with child). Medical records, child protection files, police reports, contemporaneous family statements, or criminal findings can assist.
  • Clinically significant disorder (s 9(4)/(8)) , document diagnosis of one or more listed disorders within five years before onset/worsening. Use psychiatric records, hospital admissions, prescriptions and GP notes. Note that the SOP states that "warrant ongoing management" does not require that treatment was actually given (Schedule 1 Note 2), so expert opinion that the condition would have warranted ongoing management may suffice where records are sparse.
  • Inability to obtain appropriate clinical management (s 9(9)) , demonstrate attempts to access care (referrals, waitlist documentation, correspondence, refusal letters) and explain why available options were not appropriate or accessible. Provide contemporaneous evidence of systemic barriers where possible.

• Establish relationship to relevant service (s 10(1)). The Schedule defines relevant service categories. Explain how the identified factor is connected to the claimant’s service exposure (dates of service, operational reports, postings, mission details). If relying on a factor that refers to an injury/disease covered by another SOP, identify and apply that SOP’s factors as required by s 11.

3. Address aggravation vs primary causation where relevant

• If the claimant's personality disorder pre‑existed service and the claim is that service materially contributed to or aggravated the condition, ensure that factors s 9(5)-(9) are used in the manner contemplated by s 10(2). Medical reports should distinguish between onset and aggravation and explain how service materially contributed to worsening or required ongoing management.

4. Use multi‑disciplinary medical evidence where needed

• Where multiple factors or comorbid conditions are present (for example PTSD, substance use disorder), obtain reports from psychiatrists and relevant specialists that explicitly engage with the SOP’s factors and with any other SOPs implicated by s 11. Ensure experts map their findings to SOP terms: "category 1B stressor", "clinically significant disorder within five years", "severe childhood abuse", etc.

5. Prepare documentary evidentiary bundles

• Pull together key documentary material up front: service records, operational reports/diaries, unit incident reports, police/criminal records (where relevant), hospital and GP notes, mental health clinic records, coronial findings (if death), and witness statements. For death‑related claims, ensure the expert report addresses how personality disorder contributed to the terminal event(s) listed in the Schedule (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) (s 7(5); Schedule 1).

6. Anticipate counterpoints and provide rebuttal material

• Prepare material on timing and causation to address likely challenges: e.g., evidence that onset predates service or that a condition is better explained by another medical condition. Where "inability to obtain appropriate clinical management" is claimed, pre‑emptively document why alternatives were unavailable or inappropriate.

7. Keep track of SOP versions and amendments

• Ensure the version of the SOP being applied is the one in force at the time of the decision. The endnotes show an Amendment Determination No. 87 of 2018 affected the category 1B stressor and corpse definitions (Endnotes 3-4). Use the Legislation Register or RMA publications to confirm there are no later amendments.

8. For decision‑makers: apply the SOP as written and document reasoning

• When assessing whether a reasonable hypothesis has been raised, apply the SOP's criteria exactly: verify the DSM‑5 diagnosis evidence, confirm at least one s 9 factor and that it is related to relevant service (s 10(1)), verify temporal windows, and where factors refer to other SOPs, apply those SOPs contemporaneously (s 11). Record findings on each element, and articulate reasons where evidence is insufficient.

9. Engage legal and medical expertise early

• Given the technical nature of DSM‑5 criteria, cross‑SOP interactions and temporal constraints, early engagement of a psychiatrist experienced in medico‑legal reporting and an adviser familiar with VEA/MRCA claims will improve the completeness and persuasiveness of the evidence.

10. For coronial/death cases

• If asserting death from personality disorder, ensure the medico‑legal report addresses how the personality disorder materially contributed to the terminal event listed in Schedule 1 and provides a causal chain from disorder to terminal event (s 7(5)).

Following these steps will align evidentiary materials with the instrument’s definitions and factor structure and reduce the risk that a claim fails for want of material that the SOP requires. Practitioners must pay particular attention to timing, the DSM‑5 diagnostic sufficiency, and the narrow definitions of stressors and abuse in the Schedule.