Statement of Principles concerning polyarteritis nodosa (Reasonable Hypothesis) (No. 33 of 2020)

The instrument organises a short set of legal-medical concepts that determine how polyarteritis nodosa is treated in veteran and service-related claims.

Definition of the disease: The Statement defines polyarteritis nodosa as a non-granulomatous necrotising arteritis predominantly affecting medium or small arteries (s7(2)(a)). It expressly includes cutaneous polyarteritis nodosa and single organ polyarteritis nodosa (s7(2)(b)), and it expressly excludes glomerulonephritis, Kawasaki disease, microscopic polyangiitis and polyangiitis overlap syndrome (s7(2)(c)(i)-(iv)). The instrument notes that although the condition is associated with ICD-10-AM code M30.0, the statutory meaning for claims purposes is the textual definition in subsection 7(2) rather than reliance solely on the ICD code (s7(3)-(4)).

Death and terminal events: For claims involving death, the Statement treats polyarteritis nodosa as including "death from a terminal event or condition that was contributed to by the person’s polyarteritis nodosa" (s7(5)). The Schedule defines "terminal event" as proximate or ultimate causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure or cessation of brain function (Schedule 1, terminal event).

Evidentiary threshold: The core legal-medical concept is the "reasonable hypothesis" threshold. The Repatriation Medical Authority states that there is sound medical‑scientific evidence that polyarteritis nodosa and death from it can be related to relevant service (s8). The Statement then lists specific factors which, if present and related to service, are sufficient as a minimum to raise a reasonable hypothesis linking the disease to service (s9). The claimant must establish at least one of those factors and show its relationship to the relevant service (s9; s10(1)).

Enumerated factors: Section 9 provides a closed list of factors that operate as the minimum facts for the reasonable hypothesis test. They include infection with hepatitis B, hepatitis C or HIV at the time of clinical onset or clinical worsening (s9(1)-(3), (7)-(9)); treatment with minocycline for at least 12 months before onset or worsening (s9(4), (10)); prior diagnosis of hairy cell leukaemia (s9(5)); a hepatitis B vaccination within three months before clinical onset (s9(6)); and inability to obtain appropriate clinical management for polyarteritis nodosa (s9(11)). Notes appended to relevant factors mention that antineutrophil cytoplasmic antibodies may be associated with minocycline-induced polyarteritis nodosa (s9 notes).

Relationship to service and temporal scope: The Statement requires that any factor relied upon be "related to the relevant service rendered by the person" (s10(1)). For factors in subsections 9(7) to 9(11) (the factors applying to clinical worsening and inability to obtain management), those factors apply only to claims of material contribution to, or aggravation of, polyarteritis nodosa where the disease was suffered or contracted before or during (but did not arise out of) the person's relevant service (s10(2)). This creates a temporal and causal bounding for those items: they are available to support contribution/aggravation claims, not initial causation claims that arose out of service.

Interplay with other Statements: If a listed factor refers to an injury or disease already covered by another Statement of Principles made under subsection 196B(2) of the VEA, then the factors in that other Statement apply (s11). This is an explicit cross-reference mechanism to resolve overlaps between Statements.

Definitions and scope: The instrument identifies relevant service as a set of service types under the VEA and MRCA, including operational, peacekeeping, hazardous, British nuclear test defence, warlike and non-warlike service (Schedule 1). It also defines MRCA and VEA by abbreviation (Schedule 1), and clarifies terminal event meaning (Schedule 1). The Definitions provision points back to the Schedule for other defined terms (s6).

Authority and commencement: The Statement is made under the Repatriation Medical Authority's statutory power in s196B(2) of the VEA (s3), and it commences on a fixed date (s2). It explicitly repeals the prior instrument on the same disease (s4).

Primary affected persons: The instrument primarily affects persons making claims in which polyarteritis nodosa or death from polyarteritis nodosa is alleged to be connected to relevant service, and those persons include veterans, members of Peacekeeping Forces, and members of the Forces as relevant under the VEA or the MRCA. The Statement applies to a claim to which section 120A of the VEA or section 338 of the MRCA applies (s5). The Schedule defines "relevant service" as operational service, peacekeeping service, hazardous service, British nuclear test defence service under the VEA, as well as warlike and non-warlike service under the MRCA (Schedule 1, relevant service). Consequently, claimants who rendered these categories of service are within the scope of the instrument.

Decision-makers and medical assessors: Although the instrument does not name specific claims decision-makers, it is designed for use by decision-makers applying the VEA and MRCA claim provisions referenced in s5. The Repatriation Medical Authority itself made the Statement (s3), and the Statement sets the medical criteria that will be used in assessing whether a reasonable hypothesis has been raised linking polyarteritis nodosa to service (s8-s9). Medical referees, case officers and adjudicators handling claims under the referenced statutory sections will therefore be affected in terms of the evidence they must accept as sufficient to raise the reasonable hypothesis.

Health service providers and record-keepers: Medical practitioners, hospitals and other health service providers who generate clinical records are indirectly affected, because the Statement’s factors will routinely require documented evidence: infection status for hepatitis B, hepatitis C and HIV at specified times (s9(1)-(3), (7)-(9)); treatment history for minocycline for at least 12 months before onset or worsening (s9(4), (10)); vaccination dates for hepatitis B within the three months prior to onset (s9(6)); diagnosis history for hairy cell leukaemia (s9(5)); and records documenting inability to obtain appropriate clinical management (s9(11)). The content and availability of these records will materially affect a claimant’s ability to meet the minimum factual threshold.

Beneficiaries and estates in death cases: The Statement expressly includes death from polyarteritis nodosa where death resulted from a terminal event or condition contributed to by polyarteritis nodosa (s7(5)). This brings beneficiaries and estates into scope when a deceased person’s polyarteritis nodosa is alleged to have contributed to death. The Schedule’s definition of terminal event, listing causes such as pneumonia and cardiac arrest (Schedule 1), identifies the proximate or ultimate events that may be claimed as death from polyarteritis nodosa.

Legal advisors, advocates and insurers: Practitioners advising claimants or agencies handling claims will need to apply this Statement when formulating evidentiary strategies and assessing likelihood of establishing a reasonable hypothesis. The Statement narrows the evidentiary gate to a set of documented medical or treatment facts; advisers will therefore need to direct claims-gathering and medical opinions to the factors in s9 and the requirement in s10 that factors be related to relevant service.

No new criminal or civil liabilities: The Statement itself does not create or impose criminal sanctions, statutory penalties, or private rights outside the claim process; rather, its practical effect is to shape which medical and factual circumstances are legally recognised as sufficient to raise a reasonable hypothesis connecting this disease to relevant service (s3; s5; s9).

The instrument is primarily normative in an evidentiary sense: it prescribes what must exist, as a minimum, to raise a reasonable hypothesis linking polyarteritis nodosa to relevant service. It does not create private duties of conduct in the manner of regulatory obligations, but it creates practical duties for claimants and decision-makers in the claims context.

Claimant duties, evidentiary: A claimant seeking to rely on this Statement must show at least one of the factors enumerated in section 9, and must show that the existence of that factor is related to the person's relevant service (s9; s10(1)). For claims that assert material contribution to or aggravation of pre-existing polyarteritis nodosa, the claimant can rely only on the factors listed in subsections 9(7)-(11), and those factors will only assist where the polyarteritis nodosa was suffered or contracted before or during the person's relevant service, but did not arise out of that service (s10(2)). These are evidentiary duties rather than duties of conduct: the instrument sets the elements the claimant must establish to raise the reasonable hypothesis.

Decision-maker duties, interpretative: The Repatriation Medical Authority has exercised its statutory power to set out these medical criteria (s3). In practice, adjudicators applying the VEA and MRCA provisions referenced in s5 are obliged to treat this Statement as the medical-standard instrument for assessing whether a reasonable hypothesis exists in polyarteritis nodosa claims, because that is the instrument’s legal effect under the supervisory statute (s3; s5). The Statement also requires that where a factor refers to another injury or disease covered by a different Statement, decision-makers must apply the factors in that other Statement in accordance with its terms (s11). This creates a duty on decision-makers to perform cross-Statement reading and to give effect to the other Statement where applicable.

Rights of claimants: The Statement supplies claimants with a clear list of medical and treatment-related facts which, if established and related to service, will as a minimum suffice to raise a reasonable hypothesis. This operates as a right to have a claim tested against those factors rather than against other unstated medical criteria. The Statement also clarifies that the textual definition of polyarteritis nodosa in s7(2) is the operative meaning for claims purposes, rather than relying solely on the ICD‑10‑AM code (s7(3)-(4)). Claimants therefore have the right to insist on the statutory textual definition being applied.

No statutory duties beyond claims assessment: The instrument does not itself compel clinical action, reporting, or particular conduct by health providers or third parties. It sets conditional thresholds for claims evaluation. It does not specify procedural obligations, timeframes for claim lodgement, or evidence admissibility rules; those matters are governed by the VEA and MRCA provisions referenced in s5, which are not reproduced in the instrument.

Cross-reference duty where other Statements apply: If a factor in s9 refers to a disease covered by another Statement made under subsection 196B(2) of the VEA, then the other Statement’s factors apply in accordance with its terms (s11). This creates an interpretative duty on decision-makers to locate and apply the other Statement as the governing medical standard for that referenced disease.

Practical implication: The duties imposed by this Statement are evidentiary and interpretive. Claimants must marshal specific types of clinical and treatment records itemised in s9, and decision-makers must treat the instrument as determinative of what constitutes a reasonable hypothesis as between polyarteritis nodosa and relevant service, including applying cross-Statements where factors overlap.

The Statement of Principles does not create criminal offences, civil penalties, or administrative fines in its text. It contains no penalty provisions, enforcement mechanisms, or compliance sanctions. Its legal force lies in its statutory function as a medical statement made under subsection 196B(2) of the VEA to be applied in claims assessment (s3; s5). Enforcement, in that sense, is operational rather than punitive: adherence to the Statement occurs when decision-makers apply its medical criteria to determine whether a reasonable hypothesis linking polyarteritis nodosa to relevant service has been raised by a claimant.

Administrative effect: The instrument is used by claims decision-makers under the VEA and MRCA to decide entitlement questions arising under the sections referenced in s5. The Repatriation Medical Authority’s view that there is sound medical‑scientific evidence that polyarteritis nodosa can be related to relevant service (s8) frames the medical standard, and decision-makers must apply the factors in s9 to test whether a claimant has satisfied the minimum threshold. If a claimant cannot establish at least one of the relevant factors related to service, the decision-maker will, in applying the instrument, find that a reasonable hypothesis has not been raised. That administrative outcome may result in rejection of a claim under the statutory claims process, but the Statement does not itself prescribe that outcome as a penalty.

No enforcement provisions for third parties: The Statement does not obligate medical practitioners, employers, or other third parties to provide information, nor does it create a statutory power to compel production of documents or records. Any such powers would derive from the procedural provisions of the VEA or MRCA, or general administrative law mechanisms, which are not part of this instrument.

Relevance to death claims: In death cases the Statement includes death from polyarteritis nodosa where death resulted from a terminal event or condition contributed to by polyarteritis nodosa (s7(5)). Enforcement in death cases therefore consists of applying the Statement’s criteria to determine whether the death is linked to service for entitlement purposes. Again, the Statement itself does not specify remedial consequences or penalties.

Appeal and review implications: The Statement’s absence of enforcement or penalty clauses means that any contest about its application or the sufficiency of evidence will be resolved within the appeal and review mechanisms that exist under the VEA and MRCA framework. The Statement does not itself create or modify appeal rights; it supplies the evidentiary test to be applied within the existing statutory processes referenced in s5.

Primary statutory relationship: This Statement is made under subsection 196B(2) of the Veterans' Entitlements Act 1986 (s3). It explicitly applies to claims to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 (MRCA) applies (s5). The Statement therefore enters the legal architecture of veteran and service compensation by supplying the medical criteria that decision-makers must use when assessing whether a reasonable hypothesis has been raised connecting polyarteritis nodosa to relevant service, within the processes and entitlements governed by those statutory provisions.

Cross-Statement interaction: Where a factor in this Statement refers to an injury or disease covered by another Statement of Principles made under subsection 196B(2) of the VEA, the factors in that other Statement apply in accordance with its terms (s11). This is an express mechanism for inter-Statement coherence. It means that where, for example, a listed factor invokes a disease for which there is a separate Statement, the decision-maker must apply the other Statement as the controlling medical standard for that disease, rather than attempt to recharacterise or relitigate the medical criteria within this Statement.

Role of ICD‑10‑AM codes: Subsection 7(3) and (4) state that while polyarteritis nodosa attracts ICD‑10‑AM code M30.0, the definition of the disease for the purpose of this Statement is the textual definition in s7(2). The instrument therefore prioritises the statutory textual definition over mere reliance on the ICD code. The ICD reference remains a cross-checking tool and identifies the relevant diagnostic code, but the legal meaning is the textual definition provided.

Interaction with VEA and MRCA procedures: The Statement does not reproduce or amend the procedure, time limits, appeal rights or entitlement criteria in the VEA or MRCA. It applies to claims to which particular sections of these Acts apply (s5). Thus, its practical effect depends on the decision-making, evidence rules and review paths established by those Acts. Any duties, powers or remedies not in this instrument remain under the VEA or MRCA.

Definitions tie-in: The Schedule defines "relevant service" by reference to service categories under the VEA and MRCA, and the abbreviations VEA and MRCA are provided (Schedule 1). The Schedule also defines "terminal event" for death cases, which aligns with the death provision in s7(5). These definitions ensure the Statement’s integration with the statutory vocabulary used in the VEA and MRCA.

Repeal and temporal effect: The instrument expressly repeals the prior Statement of Principles concerning polyarteritis nodosa No. 11 of 2011 (s4). Where claims straddle the repeal and replacement dates, decision-makers must apply the controlling Statement as in force. The new Statement commences on a fixed date (s2), so temporal sequencing between the repeal and commencement is straightforward in the text.

Limits of interaction: The Statement does not purport to displace other federal laws, nor does it cite or modify Workers’ Compensation, private insurance, or state health legislation. Its interaction is confined to its statutory footing under the VEA and to claims under the sections specified in s5. Any cross-jurisdictional or cross-regulatory consequences, such as impacts on other benefits, are not addressed in this instrument.

Dates and identification: The document identifies itself as the Statement of Principles concerning polyarteritis nodosa (Reasonable Hypothesis) No. 33 of 2020, dated 24 April 2020, and commencing on 25 May 2020 (s2; header). The Repatriation Medical Authority affixed its Common Seal to the instrument at the direction of its Chairperson, as recorded on the instrument's face.

Repeal of prior Statement: The Statement expressly repeals the earlier Statement of Principles concerning polyarteritis nodosa No. 11 of 2011, which is recorded as Federal Register of Legislation No. F2010L03258, made under subsection 196B(2) of the VEA (s4). The text does not list intermediate amendments between 2011 and this instrument, it only records the repeal of the 2011 Statement.

No in-text amendments recorded: The instrument does not contain an internal amendment history, schedules of past amendments, or transitional provisions beyond the repeal clause. It does not indicate whether particular claims lodged before the commencement date are to be assessed under the former or current Statement, nor does it include savings or transitional clauses. The commencement clause simply states the instrument commences on 25 May 2020 (s2), and the repeal clause removes the prior Statement (s4). Any questions about transitional application would need to be resolved by reference to the governing statutes and administrative practice, but the instrument itself provides no further detail.

Instrumental provenance: The Authority clause records that the Statement is made under subsection 196B(2) of the VEA (s3); the Explanatory material or previous versions are not included in the instrument text. The instrument’s header and signed attestation show institutional adoption by the Repatriation Medical Authority, but no further legislative amendment steps are recorded in the text.

No subsequent amendments listed: There are no schedules or later amendment notes attached to the instrument text provided. If later amendments exist, they are not part of this instrument as supplied. Users should therefore treat this text as a discrete instrument replacing the 2011 Statement as at its commencement date.

The instrument itself does not record or refer to any litigation, judicial consideration, tribunal decisions, or cases that interpret or apply this Statement. There are no cases cited in the text, and no notation of judicial review, appeals, or precedent. The Statement is a declarative, medical-standard instrument issued by the Repatriation Medical Authority under the statutory power in subsection 196B(2) of the VEA (s3).

What the text does record is the Authority’s view that "there is sound medical‑scientific evidence that indicates that polyarteritis nodosa and death from polyarteritis nodosa can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the MRCA" (s8). That statement is framed as the Authority’s evidentiary position but does not purport to summarise litigation or judicial acceptance. It is an administrative medical finding intended for use in claims determinations.

Absence of litigation references: Because the instrument includes no litigation references, the instrument provides no guidance about how courts or tribunals have construed the reasonable hypothesis concept in relation to polyarteritis nodosa, or how evidence of the listed factors has been assessed in contested cases. Any party seeking to understand the Statement’s performance in adjudication would need to consult decisions under the VEA and MRCA that apply Statements of Principles, but such case law is not supplied or cited in this instrument.

Implication for reviewers: The absence of litigation history in the instrument does not prevent judicial or tribunal review of administrative decisions that apply the Statement. The instrument will be a primary medical input in such reviews, but the text itself contains neither judicial commentary nor express guidance about how courts have treated similar Statements. For authorised legal analysis of litigation outcomes, external case law research beyond the instrument text is necessary.

Relying on the ICD code alone is insufficient: The instrument expressly states that although polyarteritis nodosa attracts ICD‑10‑AM code M30.0, the meaning of polyarteritis nodosa for the purposes of this Statement is the textual definition in subsection 7(2) (s7(3)). Practitioners should not assume that a diagnostic code in isolation establishes the statutory disease definition. The diagnostic record must support the textual criteria: non-granulomatous necrotising arteritis predominantly affecting medium or small arteries, and inclusion or exclusion criteria in s7(2).

Narrow inclusions and explicit exclusions: The Statement includes cutaneous and single organ polyarteritis nodosa (s7(2)(b)), but it expressly excludes glomerulonephritis, Kawasaki disease, microscopic polyangiitis and polyangiitis overlap syndrome (s7(2)(c)(i)-(iv)). A claimant whose pathology is better characterised by one of those excluded conditions will face a mismatch between clinical diagnosis and the statutory definition provided here.

Factor timing specifics: Several factors have tightly defined temporal or duration requirements which are strictly stated. Minocycline treatment must have been for at least 12 months before clinical onset or before clinical worsening, as the case may be (s9(4), (10)). A hepatitis B vaccination only counts if it occurred within three months before clinical onset (s9(6)). Infection with hepatitis B, hepatitis C or HIV must be present at the time of clinical onset or clinical worsening as specified (s9(1)-(3), (7)-(9)). These are threshold specifications that require corroborative time-stamped clinical documentation.

Different rules for onset and for worsening: The Statement distinguishes between factors that support a hypothesis connecting service with clinical onset of polyarteritis nodosa, and factors that support hypotheses concerning clinical worsening or material contribution/aggravation. Subsections 9(1)-(6) list factors relevant to clinical onset, while subsections 9(7)-(11) relate to clinical worsening and contribution/aggravation. Further, s10(2) caps the operation of factors in 9(7)-(11) to cases where the disease was suffered or contracted before or during, but did not arise out of, the person’s relevant service. Mistaking which factors apply to onset versus aggravation is a common procedural error.

"Related to the relevant service" requirement: It is not enough for a claimant to show a factor listed in s9; the existence of that factor must be related to the person's relevant service (s10(1)). The instrument does not define the contours of "related," nor does it give examples of what constitutes sufficient service-relatedness. Assessors must therefore perform a fact-specific linking exercise between the factor and the defined service types in Schedule 1.

Inability to obtain clinical management is a factor but vaguely worded: Subsection 9(11) lists "inability to obtain appropriate clinical management for polyarteritis nodosa" as a factor. The Statement gives no further definition of what constitutes "appropriate clinical management" or how inability is established. Moreover, s10(2) restricts the operation of this factor to material contribution or aggravation claims where the disease pre-existed or was contracted during service but did not arise out of it. Practitioners should expect this factor to require detailed evidentiary support, and decision-makers will need to interpret what "inability" means in context.

Antineutrophil cytoplasmic antibodies note tied to minocycline: Two notes remark that antineutrophil cytoplasmic antibodies may be associated with minocycline-induced polyarteritis nodosa, accompanying the minocycline factors (s9 notes). These notes are explanatory, not prescriptive, but they may be relied upon to seek specific antibody test results where minocycline exposure is alleged.

Death claims require contribution to terminal event: For death to be treated as "death from polyarteritis nodosa," the terminal event or condition must have been contributed to by the person's polyarteritis nodosa (s7(5)). The Schedule gives specific proximate causes such as pneumonia and cardiac arrest (Schedule 1). Establishing contribution to a listed terminal event will typically require medical evidence showing causation or contribution, not mere co-occurrence.

Cross-references to other Statements: If a listed factor refers to another disease covered by a separate Statement, the other Statement's factors apply (s11). Practitioners must therefore search for other Statements when factors invoke overlapping injuries or diseases. Failure to apply the other Statement where relevant will be a procedural error.

Repeal of prior Statement: Because this instrument repeals the 2011 Statement (s4), practitioners handling claims that straddle the repeal date should confirm which Statement applies to a particular claim. The instrument does not include transitional guidance, so conformance with administrative practice and the governing statutes will be necessary.

No procedural detail in the instrument: The Statement does not set out how to present evidence, the standard of proof beyond the reasonable hypothesis threshold, or review remedies. Those procedural issues are governed by the VEA and MRCA provisions referenced in s5, and the Statement does not substitute for or elaborate on them.

Evidence strategy, aligned to the instrument: Compliance for claimants means assembling documentary and clinical evidence that establishes at least one of the section 9 factors, and an evidentiary link between that factor and the person's relevant service (s9; s10(1)). The Statement supplies a finite checklist of factual predicates. Below are practical, instrument-grounded steps and types of evidence claimants and their advisers should prioritise, together with how those materials map to specific provisions.

1. Confirm the disease definition in clinical records. Ensure that diagnostic documentation supports the statutory textual definition of polyarteritis nodosa in s7(2): non-granulomatous necrotising arteritis predominantly affecting medium or small arteries. Include pathology reports, biopsy results, specialist notes and differential diagnosis materials that explicitly align the clinical diagnosis with the statutory language, and expressly exclude the conditions listed in s7(2)(c) where relevant.

2. Establish the relevant factor from section 9. Depending on which factor is relied upon, gather:

   • For hepatitis B, hepatitis C or HIV infection at time of clinical onset (s9(1)-(3)): provide laboratory reports, serology results and treating clinician notes showing positive infection markers dated contemporaneously with the clinical onset. For clinical worsening claims, provide similar evidence dated to the time of worsening (s9(7)-(9)).
   • For minocycline exposure (s9(4), (10)): provide prescription records, pharmacy dispensing records, medical notes and treatment histories showing continuous minocycline treatment for at least 12 months immediately before clinical onset or clinical worsening as alleged. Correlate treatment dates with symptom onset or documented clinical change.
   • For hairy cell leukaemia (s9(5)): supply oncological records, pathology reports and dated diagnosis notes establishing the diagnosis predates the clinical onset of polyarteritis nodosa.
   • For hepatitis B vaccination within three months before clinical onset (s9(6)): produce vaccination records and clinician notes demonstrating the date of hepatitis B vaccination and the date of clinical onset, within the three month window required by the instrument.
   • For inability to obtain appropriate clinical management (s9(11)): create a contemporaneous record trail showing attempts to access care, referrals, denial or lack of available specialist services, telehealth or evacuation logs if overseas, and contemporaneous clinician statements describing delays or lack of treatment options. Be aware this factor is limited by s10(2) where it is asserted as a material contribution/aggravation factor.

3. Relate the factor to relevant service. For each factor, prepare documentary evidence and legal submissions that tie the factor to the person’s relevant service as defined in Schedule 1, for example:

   • Match dates of infection, treatment, vaccination or inability to obtain clinical management to the periods of relevant service listed in Schedule 1.
   • For service-related infection, identify potential exposure events in service records that plausibly connect the infection to service where that is necessary to meet "related to the relevant service" (s10(1)). The instrument does not define "related," so factual linkage through service health records, incident reports, deployment medical logs, or contemporaneous entries will be required.

4. For death claims, document contribution to terminal event. If the claim concerns death, compile the death certificate, medical cause of death, terminal event documentation and medical opinions demonstrating that polyarteritis nodosa contributed to the terminal event listed in the Schedule (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) (s7(5); Schedule 1). Establishing contribution will typically require an expert medical opinion linking the disease to the proximate cause.

5. Address cross-Statement relationships. If a factor invokes another disease covered by a separate Statement (s11), obtain and rely on the relevant Statement’s factors and provide evidence that meets those factors. For example, if a factor refers to hepatitis B but a specific Statement for hepatitis B exists, include evidence aligned to that Statement.

6. Use contemporaneous records to satisfy temporal requirements. Pay special attention to the exact temporal windows and duration thresholds: minocycline at least 12 months before onset/worsening (s9(4), (10)); hepatitis B vaccination within three months before clinical onset (s9(6)); infection at the time of onset or worsening (s9(1)-(3), (7)-(9)). Timestamped medical records are the primary evidence.

7. Antibody test results for minocycline cases. Where minocycline is alleged, consider obtaining or locating antineutrophil cytoplasmic antibody test results, because the instrument notes an association between these antibodies and minocycline-induced disease (s9 notes). While the note is descriptive, antibody results will assist in substantiating a minocycline link.

8. Provide narrative linkage and expert opinion. Because the instrument’s threshold is the "reasonable hypothesis," expert medical opinions that explain how the documented factor could plausibly link polyarteritis nodosa to service are likely to be influential. Experts should reference the Statement’s elements and explain the temporal and causal connections.

9. Be mindful of exclusions and differential diagnoses. Ensure that clinical records address and, if necessary, rule out the conditions the Statement excludes (s7(2)(c)(i)-(iv)), and provide clear diagnostic reasoning in specialist reports.

10. Consider scope of s10(2) for contribution/aggravation claims. If asserting material contribution or aggravation under factors 9(7)-(11), confirm the disease pre-dated or began during service and did not arise out of it. Compile earlier medical records to show pre-existence where required (s10(2)).

11. Check applicability dates and prior Statements. If a claim concerns events close to the repeal and commencement dates, verify which Statement applied at the time a claim was lodged, recognising this instrument repeals the 2011 Statement (s4) and commenced on 25 May 2020 (s2). If necessary, include both prior and current Statement factors for completeness, and seek direction on transitional application within the governing statutory process.

12. Prepare for cross-checking in claims assessment. Because the Statement is used by decision-makers as the medical standard in claims assessment, present evidence in a way that directly maps to the numbered factors in s9 and to the relationship requirement in s10(1). Numbered exhibits aligned to the Statement will assist assessors in applying the instrument’s criteria.

Limitations: The Statement does not set out claim lodgement procedures, standard of proof beyond saying a reasonable hypothesis must be raised, or appeal processes; those procedural matters are governed by the VEA and MRCA sections referenced in s5. Compliance therefore involves producing the right factual and medical material rather than following new procedural rules contained in this Statement.