Statement of Principles concerning pinguecula (Balance of Probabilities) (No. 61 of 2024)

The instrument rests on a small set of tightly specified medical and causal concepts. These are expressed in statutory text rather than loose medical commentary, and they drive eligibility determinations for service connection under the VEA and MRCA claim mechanisms that the SoP applies to (s 5).

Pinguecula. The SoP defines pinguecula as a small, raised benign elastotic conjunctival degeneration presenting as a fatty nodule near the temporal or nasal limbus of the eye, and it expressly excludes pterygium (s 7(2)). The instrument notes the ICD‑10‑AM code H11.1 but states that the statutory meaning is the one given in s 7(2) (s 7(3)-(4)). Death from pinguecula. The SoP extends the notion of pinguecula to include death from a terminal event or condition that was contributed to by the person’s pinguecula (s 7(5)). Schedule 1 defines "terminal event" as the proximate or ultimate cause of death with examples such as pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (Schedule 1, terminal event).

Causation standard and evidence base. The Authority frames its position in terms of "more probable than not" and states that this conclusion is based on the "sound medical‑scientific evidence available" (s 8). The instrument’s title and s 8 locate determinations on the civil standard of proof, balance of probabilities.

Factors that must exist. Section 9 lists the discrete factual predicates that must be present for a link to relevant service to be made on the balance of probabilities. The first is quantified sunlight exposure to the unprotected eye (at least 4,500 hours in a tropical area, or latitude‑equivalent hours otherwise). The instrument provides the calculation method for latitude equivalence via multipliers for different latitude bands (s 9(1) and the Note to s 9). The second, alternative factor is inability to obtain appropriate clinical management for pinguecula before clinical worsening (s 9(2)).

Relationship to relevant service. Section 10 requires factors in s 9 to be related to the person’s relevant service as defined in Schedule 1. Subsection 10(2) limits the operation of the "inability to obtain appropriate clinical management" factor to matters of material contribution or aggravation where the pinguecula was suffered or contracted before or during, but did not arise out of, relevant service.

Interaction with other SoPs. Section 11 provides that where a factor in s 9 refers to an injury or disease covered by another Statement of Principles, the factors in that other SoP apply in accordance with its terms as in force from time to time.

Definitions. The Schedule consolidates definitions the instrument relies on, including relevant service (eligible war service, defence service, or peacetime service under MRCA), VEA, MRCA, pinguecula (see s 7(2)) and terminal event (Schedule 1).

These concepts are the operative vocabulary decision‑makers must apply when using the SoP to determine service connection in relevant claims.

The instrument affects claimants seeking a determination that pinguecula, or death from pinguecula, is connected with their relevant service for the purposes of entitlements under the Veterans' Entitlements Act 1986 or the Military Rehabilitation and Compensation Act 2004. Section 5 expressly limits the SoP’s application to claims to which s 120B of the VEA or s 339 of the MRCA apply. Schedule 1 defines "relevant service" to include 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, and peacetime service under the MRCA. That definitional choice determines the population whose service may be tested against the SoP’s factors.

Who bears the factual task. The instrument itself does not set out procedural responsibilities or evidentiary burdens in procedural detail, but it establishes the factual predicates that must be shown on the balance of probabilities (s 8, title). Practically, this means claimants who assert service connection must adduce evidence sufficient to satisfy decision makers that at least one of the factors in s 9 existed and was related to the claimant’s relevant service as required by s 10. The SoP is therefore directly material to claimants, legal advisers and medical assessors compiling material to prove service connection.

Who decides. The Repatriation Medical Authority is the statutory author (s 3). Thereafter, the SoP is used by decision‑makers administering the VEA and MRCA claims processes referenced in s 5; the instrument itself does not stipulate which administrative officer or tribunal makes the entitlement decision, but it supplies the medical causation framework those decision‑makers must apply.

Indirectly affected parties. Treating clinicians, including ophthalmologists and general practitioners, will be asked to document diagnosis dates, clinical onset and worsening, and to comment on attempts to obtain appropriate management where relevant. Employers or unit commanders may be asked to provide service location and duty records that can corroborate hours of sunlight exposure calculated under s 9(1) and its latitude equivalence provisions.

Temporal scope. The instrument commences 24 September 2024 (s 2) and repeals the 2015 SoP for pinguecula (s 4). The repeal means that determinations made after commencement for claims falling within the statutory claim regimes will use this SoP rather than the repealed instrument.

In short, the SoP is a technical instrument that changes the medical causation criteria for a defined group of claimants under VEA and MRCA claim provisions and thereby affects claimants, their advisers, medical evidence preparers, and administrative decision makers.

The instrument does not create new statutory duties in the criminal law sense. Its primary legal effect is to set out the medical and causal criteria that must be met for pinguecula or death from pinguecula to be accepted, on the balance of probabilities, as connected with relevant service for claims under the cited provisions (s 5, s 8, s 9). The rights and duties that follow are therefore procedural and evidentiary rather than regulatory prohibitions or obligations.

Claimant duties implied by the SoP. A claimant asserting service connection for pinguecula must establish, on the balance of probabilities, that at least one of the factors in s 9 existed and that the factor is related to the claimant’s relevant service (s 9; s 10(1)). For the sunlight exposure factor that means demonstrating exposure to the unprotected eye amounting to at least 4,500 hours in tropical latitudes, or equivalent hours calculated using the latitude multipliers set out in the instrument (s 9(1) and note). For the inability to obtain appropriate clinical management factor, the claimant must demonstrate that they were unable to obtain appropriate clinical management before clinical worsening (s 9(2)), and per s 10(2) that this factor applies only where the pinguecula was suffered or contracted before or during relevant service but did not arise out of service.

Decision‑maker duties. Decision makers applying the VEA or MRCA claims framework must apply this SoP as the authoritative Statement of Principles for pinguecula from commencement. Section 11 requires that where a factor in s 9 refers to an injury or disease covered by another SoP, the factors in that other SoP apply according to their terms as in force. Subsection 7(3) clarifies that although pinguecula attracts ICD‑10‑AM code H11.1, the SoP’s meaning of pinguecula is the statutory definition in s 7(2). The authority for the SoP is expressly s 196B(3) of the VEA (s 3), so administrative decision makers must treat it as determined under that statutory power.

Right to have causation assessed on balance of probabilities. The instrument states the Authority’s view that, on the balance of probabilities, pinguecula can be related to relevant service (s 8). That framing aligns the SoP with a civil standard of proof for causation assessments for covered claims. The instrument does not itself set out appeal routes or procedural safeguards; those remain governed by the VEA, MRCA and associated administrative processes.

Repeal and transitional effect. The instrument repeals the 2015 SoP (s 4). Practitioners should note that after commencement the new SoP is the operative medical causation instrument for pinguecula. The instrument does not itself specify transitional arrangements for claims pending at commencement; the plain effect is to replace the previous SoP in the applied medical‑causation framework for claims to which s 120B VEA or s 339 MRCA apply.

Summary. The SoP imposes an evidentiary duty on claimants to establish one of the enumerated factors and their relationship to relevant service. It confers the right to have causation determined according to the specified factors and the balance of probabilities standard. It places an operational duty on decision makers to apply this SoP and to import the terms of other SoPs where s 11 directs.

The Statement of Principles itself does not create penalties, offences or monetary sanctions. The instrument is a medical causation instrument that determines the factors to be used to assess whether pinguecula, or death from pinguecula, is connected to relevant service for the purpose of entitlement provisions under the VEA or MRCA (s 5; s 3). It does not specify enforcement mechanisms, compliance penalties, or administrative sanctions within its text.

Enforcement context. The practical enforcement context is the claims and adjudication processes under the VEA and MRCA. The SoP sets criteria decision makers must use when determining causation. Any enforcement mechanisms, penalties for false claims, or sanctions for non‑compliance with administrative requirements would be those established in the VEA, MRCA and governing regulations and not in this SoP. The instrument does not itself refer to those sanctions or to the internal procedures of decision makers.

Administrative effect on decision makers. The instrument creates an obligation for administrative decision makers to apply the SoP (s 3 and s 5), and to treat it as the applicable statement of medical causation for pinguecula from its commencement date (s 2, s 4). Failure by an administering agency to apply the SoP when required could be a ground of administrative review or appeal under the VEA or MRCA processes, but the instrument contains no provision about review rights or remedies.

Evidence and probative thresholds. The SoP establishes the factual thresholds to be met for a finding on the balance of probabilities (s 8, s 9). Where a claimant fails to meet those thresholds, the natural consequence is a negative entitlement decision under the VEA/MRCA frameworks. The instrument does not create discrete remedial orders; remedies for adverse decisions remain those available under the VEA, MRCA and associated review tribunals or courts.

Relevance of repeal. The repeal of the prior SoP (s 4) means that the previous instrument no longer operates as the Statement of Principles for pinguecula. The instrument does not provide transitional enforcement rules; any enforcement consequences of that repeal must be inferred from the timing of the instrument’s commencement and the applicable provisions of the VEA and MRCA.

In sum, this SoP is an evidentiary and substantive causation instrument used in entitlement determinations. It does not by itself create criminal or civil penalties, and enforcement arises through the VEA/MRCA administrative claim and review framework rather than via provisions contained in the instrument.

This instrument is expressly enacted under the VEA power and operates in relation to claims under the VEA and the MRCA. Section 3 states the authority as subsection 196B(3) of the VEA. Section 5 limits application to claims to which s 120B of the VEA or s 339 of the MRCA apply, thereby tying the instrument directly into those statutory claim pathways. Schedule 1 defines "relevant service" by reference to categories of service under the VEA and MRCA; the instrument therefore imports the eligibility categories used by those Acts (Schedule 1, relevant service).

Interaction with other Statements of Principles. Section 11 provides an explicit cross‑instrument interaction rule. If a factor in s 9 refers to an injury or disease covered by another SoP determined under subsection 196B(3) of the VEA, then the factors in that other SoP apply according to its terms as in force from time to time (s 11). That creates a mechanism for overlapping medical causation rules to be reconciled by following the currently operative terms of the other SoP. The instrument therefore anticipates and provides for cross‑referencing among SoPs rather than attempting to replicate other instruments.

ICD‑10‑AM code and classification. The instrument notes that pinguecula attracts ICD‑10‑AM code H11.1 but makes clear that the legal meaning for the SoP is the statutory definition in s 7(2) (s 7(3)). Subsection 7(4) specifies which edition and effective date of ICD‑10‑AM is being referenced, and acknowledges its copyright owner. That means medical coding systems are acknowledged but not determinative of the SoP’s statutory definition.

Repeal of prior instrument. Section 4 repeals the Statement of Principles concerning pinguecula No. 119 of 2015. That repeal has an effect in the body of law: after the commencement date the 2015 SoP no longer operates as the medical causation instrument for pinguecula. The instrument does not enact explicit transitional rules governing claims that were pending under the old SoP; the operative effect is a replacement of the medical causation framework.

Relation to VEA/MRCA procedural provisions. The instrument does not itself restate procedural or review mechanisms in the VEA or MRCA. It must be used in conjunction with those Acts’ procedural provisions. For example, the terms "relevant service", "eligible war service", "defence service" and "peacetime service" are defined in Schedule 1 and map back to the service categories used by the VEA and MRCA; the SoP therefore slots into the factual matrix those Acts require for entitlement decisions.

Absence of external standards. The instrument does not cross‑reference other Acts for enforcement, nor does it create regulatory obligations under occupational health, privacy, or records legislation. It is a medical causation instrument to be applied within the statutory compensation frameworks cited.

In short, the SoP is designed to be read and applied within the statutory architecture of the VEA and MRCA, interacts by cross‑reference with other SoPs, acknowledges but does not defer to ICD‑10‑AM coding, and replaces the prior 2015 SoP for pinguecula.

This instrument records a clean substitution rather than a chain of iterative amendments within this text. The document itself states a single explicit amendment action: the repeal of the Statement of Principles concerning pinguecula (Balance of Probabilities) No. 119 of 2015 (Federal Register of Legislation No. F2015L01672) (s 4). The new SoP is dated 20 August 2024 and commences on 24 September 2024 (headnote date, s 2). Professor Terence Campbell AM is recorded as Chairperson signing on behalf of the Repatriation Medical Authority in the instrument’s heading.

No other amendments are recorded in the instrument. There are no in‑text variation clauses that amend or vary earlier paragraphs within the same instrument. The Schedule provides the definitions used by the instrument as enacted; there is no transitional scheduling beyond the repeal provision (s 4).

What the text reveals about amendment practice. The statutory mechanism used is subsection 196B(3) of the VEA, under which the Repatriation Medical Authority determines Statements of Principles. The instrument follows a common pattern for SoPs: it specifies the condition, defines its medical meaning for statutory purposes, states the causation factors and their relationship to relevant service, and provides definitional material in a schedule. The 2015 SoP is expressly repealed, meaning that from the commencement date the medical causation criteria for pinguecula are those contained in this instrument rather than in the 2015 instrument. The instrument does not include a saving or transitional provision for determinations made before commencement.

Implications for practitioners. Practitioners should treat the 2015 SoP as no longer in force from 24 September 2024 and use the criteria and definitions contained in this instrument for any assessments or submissions on or after that date that fall within s 120B of the VEA or s 339 of the MRCA. If a subsequent amendment or replacement SoP is made, the instrument’s s 11 mechanism indicates the Authority expects SoPs to be current and cross‑referenced; any future amendments would be captured by a replacement instrument replicating or varying the structure used here.

No other historical amendments or amendments-by-reference are included in the instrument; the entire amendment history recorded within the text is the repeal of the 2015 SoP and the commencement date of the new SoP.

The instrument itself contains no litigation history. It does not cite any cases, judicial decisions, tribunal determinations, or adversarial proceedings. There is no textual reference to prior litigation that influenced the drafting, no footnoted authorities, and no description of judicial interpretation of the earlier 2015 SoP. The only judicially relevant material in the instrument is its status as a Statement of Principles determined under subsection 196B(3) of the VEA and its role in the adjudicative framework used for claims under the VEA and MRCA (s 3; s 5).

What the absence of litigation materials means in practice. The instrument’s absence of recorded litigation does not prevent disputes arising in future about its interpretation. Potential points of interpretative contention include the meaning and proof of "unprotected eye", the measurement and proof of "4,500 hours" and "latitude equivalent hours" using the multipliers in s 9(1) and its Note, what constitutes "appropriate clinical management" and when clinical worsening has occurred, and how to apply s 10(2) where a pinguecula predates service. The instrument itself provides precise numerical and definitional rules for several matters, for example the latitude multipliers used to calculate equivalent sunlight exposure (s 9 and Note). Those prescriptive provisions will narrow disputes about certain quantification issues but leave fact‑finding discretion to decision makers.

Likely procedural setting for disputes. Any challenge to the application of this SoP in an entitlement decision will be litigated, if pursued, within the review and appeals framework provided by the VEA and MRCA and the relevant tribunals and courts. The instrument does not describe those procedures; practitioners must look to the VEA and MRCA for appeal routes, time limits and procedural rules. The SoP will be evidence of the medical causation criteria to be applied by decision makers and, if necessary, reviewed by tribunals or courts.

Consequence for evidence production. The lack of precedent cited in the SoP means that claimants and advisers should expect that interpretation of ambiguous terms or borderline factual situations will be decided on a case‑by‑case basis by decision makers and, ultimately, by reviewing tribunals or courts. Absent judicial guidance printed in the instrument, practitioners should prepare factual and medical evidence targeted to the specific textual criteria set out in s 7-s 11 and the Schedule.

In summary, there is no litigation history recorded in the instrument itself; any disputes arising from its application will need to be addressed through the VEA/MRCA review and appeal mechanisms and will be decided on the wording and structure the instrument supplies.

The instrument contains precise provisions and several points where practical or interpretive risks arise for claimants, practitioners and decision makers. These "gotchas" are matters the text raises or leaves ambiguous and that are likely to affect proof, administration and litigation.

Balance of probabilities standard. The SoP is cast for determinations on the balance of probabilities (title; s 8). Practitioners should note that this is a civil standard; however, the instrument does not elaborate evidentiary procedures. The claimant must satisfy decision makers that at least one factor in s 9 existed and was related to relevant service (s 9; s 10(1)).

Quantification and proof of sunlight exposure. The primary quantitative threshold is "having sunlight exposure to the unprotected eye for at least 4,500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones" before clinical onset (s 9(1)). The instrument sets out a latitude equivalence calculation with multipliers: tropical latitudes (23.5° Sth to 23.5° Nth) ×1.0; subtropical (23.6°-35°) ×0.75; warm temperate (35.1°-45°) ×0.5; cool temperate (45.1°-65°) ×0.25 (s 9 note). Gotchas here include proving the hours, mapping service locations to the latitude bands specified, and aggregating hours across regions using the multipliers. The instrument prescribes the calculation method but not acceptable evidence for hours, how to allocate hours to the "unprotected eye", or how to treat intermittent protective measures.

Terms not defined in the Schedule. Several terms central to the causation analysis are not defined in the instrument. Examples include "unprotected eye", "clinical onset", "clinical worsening", and "appropriate clinical management". The Schedule defines pinguecula, relevant service, terminal event and the statutory Act abbreviations, but it does not define those other operational terms. That lack of definition creates interpretive discretion for decision makers and possible disputes about meaning.

Scope of the "inability to obtain appropriate clinical management" factor. Section 9(2) provides an alternative factor: inability to obtain appropriate clinical management before clinical worsening. Section 10(2) curtails its operation to circumstances of material contribution or aggravation where the pinguecula was suffered or contracted before or during service but did not arise out of service. Practitioners must note two things. First, this factor is not available to cases where the pinguecula arose out of service. Second, the instrument requires the inability to obtain management to precede clinical worsening, but does not detail what evidence suffices to show unsuccessful attempts, access barriers, or timing of worsening.

Death from pinguecula and terminal event scope. Section 7(5) includes death from a terminal event or condition contributed to by the person’s pinguecula. The Schedule defines terminal event with examples (pneumonia; respiratory failure; cardiac arrest; circulatory failure; cessation of brain function). A gotcha is that the instrument requires a causal contribution, not necessarily sole causation. Practitioners will need to link pinguecula to the terminal event on the balance of probabilities, but the instrument does not set out medical thresholds for demonstrating contribution.

Interaction with other SoPs. Section 11 requires reference to other SoPs where s 9 factors refer to other conditions. The gotcha is that overlapping conditions must be treated according to the other SoP(s) "as in force from time to time", which introduces potential variability across time and may require cross‑checking multiple SoPs.

Repeal timing. The instrument repeals the 2015 SoP (s 4) and commences on a future date (s 2). Claims straddling the commencement date need careful handling. The instrument does not include savings provisions; practitioners should verify which SoP was applicable at the time key events and decisions occurred.

ICD‑10‑AM coding not determinative. Subsection 7(3) disclaims reliance on the ICD‑10‑AM code alone and instructs that the statutory definition governs. A gotcha would be over‑reliance on coded diagnoses rather than clinical description meeting the statutory definition.

In summary, the principal practical hazards are proving and mapping quantified sun exposure under the specified latitude multipliers, the absence of definitions for several operational terms, the constrained application of the "inability to obtain appropriate clinical management" factor, and the need to reconcile other SoPs where relevant. Each of these matters creates evidentiary and interpretive friction points for claim preparation and adjudication.

Compliance here means assembling and presenting the factual and medical evidence decision makers need to reach a positive causation finding under the SoP’s criteria and ensuring procedural conformity with the VEA or MRCA claims processes. The SoP sets out three tasks a claimant or practitioner must address and the textual mechanisms to do so.

1. Establish relevant service. The SoP applies only to claims to which s 120B of the VEA or s 339 of the MRCA apply (s 5). Schedule 1 defines relevant service as eligible war service (other than operational service), defence service (other than hazardous service and British nuclear test defence service) under the VEA, or peacetime service under the MRCA (Schedule 1). Compile and lodge service records sufficient to demonstrate the claimant’s category of relevant service under the VEA or MRCA. That documentation determines whether the SoP is engaged.

2. Meet the causation threshold on the balance of probabilities. The Authority’s view is framed as being "more probable than not" that pinguecula can be related to relevant service (s 8). Practically, you must demonstrate at least one of the s 9 factors and its relationship to relevant service under s 10. There are two alternative routes:

   • Sunlight exposure route (s 9(1)). Assemble evidence to show sunlight exposure to the unprotected eye that meets or exceeds 4,500 hours in a tropical area, or latitude‑equivalent hours using the multipliers prescribed in the instrument (s 9(1) and the Note). Steps to take:

     • Map deployment/service locations to latitude bands per the Note (tropical 23.5° Sth-23.5° Nth; subtropical 23.6°-35°; warm temperate 35.1°-45°; cool temperate 45.1°-65°) as the instrument prescribes.
     • Calculate hours spent outdoors at duty stations in those latitude bands; apply the multipliers (1.0, 0.75, 0.5, 0.25) and add latitude‑equivalent hours to reach the threshold.
     • Use service logs, unit diaries, attendance records, mission statements, duty rosters and personal contemporaneous records to substantiate hours outdoors. Clinical onset must be before the sunlight exposure cut‑off in the calculation; the SoP requires exposure "before clinical onset" (s 9(1)).
     • Obtain medical and ophthalmological records that document diagnosis and clinical onset dates for pinguecula (s 7(2); s 9(1)). Remember the SoP’s statutory definition of pinguecula governs despite ICD coding (s 7(3)-(4)).

   • Clinical management route (s 9(2) and s 10(2)). Where the claimant’s pinguecula was suffered or contracted before or during but did not arise out of service, demonstrate that there was an inability to obtain appropriate clinical management before clinical worsening (s 9(2); s 10(2)). Steps:

     • Assemble contemporaneous clinical records showing diagnosis date and subsequent course, including any clinical worsening and dates.
     • Document attempts to obtain appropriate clinical management, including dates, referrals, appointments missed or unavailable, administrative barriers, travel or access limitations, and any correspondence. The SoP does not define "appropriate clinical management", so provide clinician statements on what management was clinically appropriate and whether access was obtained.
     • Ensure the evidence links the inability to obtain care to material contribution or aggravation of the condition, as required by s 10(2).

3. Where death is claimed, link pinguecula to terminal event. For a death claim, demonstrate that the person’s pinguecula contributed to the terminal event or condition causing death (s 7(5)). Use the Schedule’s list of terminal events and frame medical evidence to show a contributory link on the balance of probabilities. Provide death certificates, coronial findings if any, hospital records and treating clinician statements tying pinguecula to the terminal event.

Additional practical measures:

• Use the statutory definition of pinguecula. Ensure clinical descriptions align with the SoP’s definition in s 7(2) rather than relying solely on ICD‑10‑AM coding (s 7(3)-(4)).

• Check for overlapping SoPs. If any factor in s 9 refers to an injury or disease covered by another SoP, identify and apply the other SoP’s factors as in force (s 11). Cross‑reference relevant SoPs when compiling medical arguments.

• Address evidentiary ambiguities proactively. Because terms like "unprotected eye", "clinical onset" and "appropriate clinical management" are not defined in the Schedule, have treating clinicians provide opinion evidence clarifying these terms as applied to the claimant’s facts and linking clinical timelines to service records.

• Calculate latitude‑equivalent exposure carefully. Follow the multipliers set out in the instrument. Document the methodology used for hours calculation and preserve sources for each element of the hours claimed.

• Time applications around commencement. The SoP commences 24 September 2024 and repeals the 2015 SoP (s 2, s 4). For claims and assessments near that date, confirm which SoP applies to key events and ensure the evidence meets the criteria of the applicable instrument.

• Prepare for challenge. The SoP provides the criteria; decision makers and reviewers will apply them to the assembled evidence. Ensure records are comprehensive, clinicians articulate causal links, and calculations and service mappings are transparent and reproducible.

This is a text‑driven instrument: compliance requires assembling factual proof tailored to the numeric and textual thresholds the SoP prescribes and ensuring the SoP’s definitions and cross‑references are addressed in the evidence.