Statement of Principles concerning psoriasis (Reasonable Hypothesis) (No. 13 of 2021)

The SoP is structured around a small set of core concepts that decision‑makers and advisers must track. These concepts are expressed as statutory definitions or operative rules in the instrument.

1. Clinical definition of the condition: psoriasis is defined clinically, not merely by ICD code. The SoP says psoriasis “means a chronic inflammatory skin disorder characterised by keratinocyte hyperproliferation that results in erythematous plaques, patches and papules” (s7(2)). Although ICD‑10‑AM codes are listed (s7(3)-(4)), the SoP insists the clinical definition in s7(2) is the operative meaning for the instrument. This matters for claims where coding in records may differ from the clinical description.

2. Death from psoriasis: the SoP treats death from psoriasis as death from a terminal event or condition that was contributed to by psoriasis (s7(5)). The Schedule defines “terminal event” by example (pneumonia, respiratory failure, cardiac arrest, circulatory failure or cessation of brain function), directing decision‑makers to consider contribution to these proximate causes (Schedule, terminal event).

3. Reasonable hypothesis and evidentiary threshold: the SoP lists factors which, if present and related to relevant service, raise a reasonable hypothesis that psoriasis is related to service. Section 8 records the RMA’s view that there is “sound medical‑scientific evidence” indicating such relationships. The legislative construct is predictable: presence of at least one listed factor with the requisite timing and exposure metric is the minimum factual basis for a reasonable hypothesis (s9 preamble).

4. Temporal windows and quantitative thresholds: each listed factor carries a precise temporal window (for example, 30 days before clinical onset for skin injury, seven days for exposure to a specified drug, six months for withdrawal from tumour necrosis factor‑α inhibitors or certain stressors, or one year with average alcohol consumption of at least 200 g/week) and quantified measures (e.g. BMI of 25 or greater sustained for five years, at least five pack‑years of tobacco, 5,000 hours of second‑hand smoke exposure) (s9; Schedule definitions). These thresholds convert clinical and lifestyle histories into discrete evidentiary triggers.

5. Onset versus worsening/aggravation: the SoP differentiates between “clinical onset” and “clinical worsening” of psoriasis. Factors (1)-(15) address clinical onset; factors (16)-(29) mirror many of the same items for clinical worsening; factor (30) is inability to obtain appropriate clinical management and applies to worsening/aggravation (s9(1)-(30)). Section 10(2) clarifies that subsections 9(16)-9(30) apply only to material contribution to, or aggravation of, psoriasis where the psoriasis was suffered or contracted before or during the person’s relevant service.

6. Relationship to relevant service: the SoP requires that any factor relied on be related to the person’s relevant service (s10(1)). Relevant service is defined in the Schedule and includes operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike or non‑warlike service under the MRCA (Schedule, relevant service).

7. Cross‑SoP references: where a factor refers to an injury or disease covered by another SoP, the terms of that other SoP govern (s11).

8. Defined exposure types and classifications: the Schedule supplies operational meanings for “being exposed to second‑hand smoke”, “being overweight or obese” (BMI ≥25), “biologic agent”, classification of stressors into category 1A, 1B and 2, “one pack‑year” and examples of high and moderate potency topical glucocorticoids (Schedule).

9. Specified list of drugs: the Schedule lists specific drug classes and named drugs that are qualifying exposures for several factors (e.g. ACE inhibitors, beta‑blockers, bupropion, chloroquine, hydroxychloroquine, lithium, tetracyclines, certain antifungals, oncological agents and “biologic agents for the treatment of cancer and autoimmune disease”) (Schedule, specified list of drugs).

For practitioners, these concepts convert clinical and historical material into binary or thresholded utilities: either a prescribed factor is documented within the required window/threshold and related to relevant service, thereby raising the reasonable hypothesis; or the factor is absent or not related to service, in which case the SoP’s minimum standard is not met. The SoP’s definitions often specify numeric or categorical measures (e.g. BMI ≥25, 200 g alcohol/week, 5,000 hours of second‑hand smoke exposure, seven days’ drug exposure) that must be proved or disproved on the available medical and social history.

Primary affected parties

• Claimants: veterans, members of Peacekeeping Forces, and members of the Forces whose claims fall under section 120A of the VEA or section 338 of the MRCA (s5). The SoP applies to claims addressing psoriasis or death from psoriasis (s7(1) and s5).
• Decision‑makers and clinicians: administrative decision‑makers and medical practitioners preparing opinions for VEA/MRCA claims will use the SoP’s definitions, timing windows and quantitative thresholds (s7-s11; Schedule). The RMA’s view that “sound medical‑scientific evidence” supports the link between psoriasis and relevant service (s8) guides decision‑makers’ evaluative posture.

Secondary affected parties and systems

• Medical record custodians: general practitioners, dermatologists, hospitals and allied health services will be sources of the specific evidence the SoP requires: drug histories (including timing and withdrawal), infection episodes, BMI data across time, alcohol intake history, smoking history and second‑hand smoke exposure, documentation of injuries to skin and pregnancy history for impetigo herpetiformis (s9; Schedule).
• Case managers and legal advisers for claimants: need to assemble evidence showing the presence of at least one factor, with the correct temporal relation to clinical onset or worsening, and to connect that factor to relevant service (s9; s10(1)-(2)).

Who is not directly affected by the instrument

• Members of the public outside the veteran/military claim context who do not pursue claims under the VEA or MRCA are not directly governed by this SoP. The instrument has no direct criminal sanctions, taxes or licensing effects. It is not a clinical practice guideline for the general population; its function is adjudicative and evidentiary within the VEA/MRCA claim processes (s3, s5, s8-s11).

Distribution of costs and benefits

• Potential concentrated benefits accrue to claimants who can demonstrate one or more of the listed factors linked to relevant service; this presence may reduce the burden of establishing causation in a claim because the SoP provides a statutory evidentiary trigger (s9).
• Costs are largely administrative and evidentiary: claimants and advisers must assemble detailed lifestyle and medical histories meeting precise temporal and quantitative thresholds (for example, proving 5,000 hours of second‑hand smoke exposure, or BMI ≥25 for five years) (s9; Schedule). Decision‑makers must apply the SoP, cross‑refer to other SoPs where relevant (s11), and interpret undefined terms (for example “clinical onset” and “clinical worsening”) when adjudicating claims.

Who decides

• The RMA made the SoP and expresses the scientific view that underpins it (s3, s8). The SoP itself will be applied by the decision‑makers and tribunals responsible for VEA and MRCA claims; the instrument does not specify who in the adjudicative chain decides claims (it operates as an evidentiary standard for those statutory claim processes) (s5).

Practical implications for service members/veterans

• Individuals whose medical history includes the defined factors at the specified intensity and timing, and who can show a relationship to relevant service, may satisfy the minimum factual basis required for a reasonable hypothesis that their psoriasis is service‑related (s9; s10(1)). Conversely, absence of such documented factors may increase the evidentiary burden on the claimant.

What the instrument requires and confers

• No new criminal or civil duties are imposed by this SoP itself. It does not create duties on private persons expressed in terms of obligations enforceable by penalties. Instead, it prescribes the factual framework decision‑makers must use in assessing causation or contribution in VEA/MRCA claims for psoriasis (s3, s5, s8-s11).
• Right to rely on the SoP as an evidentiary foundation: for claimants and their advisers, the SoP supplies a catalogue of factors that, if present and linked to relevant service, meet the minimum for raising a reasonable hypothesis connecting psoriasis to service (s9; s10). Practically, this assists claimants in structuring evidence and medico‑legal opinions.
• Duty on decision‑makers to apply the SoP when assessing claims within the VEA/MRCA framework: the instrument is made under s196B(2) VEA (s3) and applies to specified claims (s5), which means decision‑makers will treat the SoP as the prescribed Statement of Principles for psoriasis. The SoP itself does not set procedural duties beyond the definition of terms and factors, but it is the substantive standard for determining whether a “reasonable hypothesis” exists.

Operational elements decision‑makers must respect

• The requirement that any factor relied on be related to the person’s relevant service (s10(1)). It is not enough that a factor exists; a causal or contextual link to relevant service must be established.
• The distinction between clinical onset and clinical worsening/aggravation: when psoriasis predates service, factors mapped to subsections 9(16) to 9(30) apply only to material contribution or aggravation (s10(2)). Decision‑makers must therefore distinguish between causation of a new disease and aggravation of a pre‑existing disease.

Evidence standards implied by the instrument

• The SoP sets minimum factual requirements for raising a reasonable hypothesis: presence of at least one qualifying factor with the stated timing and thresholds (s9). It does not itself specify the standard of proof required for a final finding (that standard is governed by the VEA/MRCA and tribunal practice), but by defining the threshold for a “reasonable hypothesis”, the SoP constrains the initial evidentiary hurdle claimants must clear.
• Operational definitions convert clinical narratives into discrete evidentiary elements: for example, “being overweight or obese” is defined as BMI ≥25 (Schedule); “one pack‑year” is defined and quantified (Schedule; amended 2022); “being exposed to second‑hand smoke” requires enclosed‑space inhalation and a threshold of 5,000 hours (s9(13) and Schedule). These definitions narrow the types of evidence that will suffice.

Interaction with other Statements of Principles

• If a factor in this SoP refers to an injury or disease covered by another SoP, the other SoP applies as in force (s11). That mechanism delegates substantive treatment of certain comorbid or causally linked conditions to their own SoPs.

Limits on rights

• The SoP does not establish an entitlement to benefit per se; it merely establishes the minimum factual base for raising a reasonable hypothesis that may lead to acceptance under the VEA/MRCA processes. Entitlement determinations remain subject to the broader statutory tests in the VEA or MRCA and to decision‑maker discretion in applying medical evidence.

No penalties within the instrument

• The Statement of Principles contains no express penalties, fines, criminal sanctions, licensing conditions, or enforcement powers. It is an evidentiary and definitional instrument rather than a regulatory instrument that imposes sanctions. The text of the SoP contains no enforcement provisions (see whole instrument; notably s3-s11 and the Schedule).

How the SoP is enforced in practice

• The SoP is applied by decision‑makers administering claims under the VEA and MRCA (s5). Enforcement in effect occurs through administrative decision‑making: a decision maker may accept or reject a claim according to whether the facts of the claim satisfy the SoP’s factors, and this will determine access to statutory benefits under the parent statutes. The instrument itself does not authorise or describe those benefit mechanisms,those arise under the VEA and MRCA.
• Administrative review and judicial review mechanisms under the VEA and MRCA (and the judicial review regime) remain the channels through which claim rejections based on the SoP’s application can be challenged. The SoP contains no procedural or tribunal rules itself; its role is substantive: to guide whether a reasonable hypothesis exists regarding service causation or contribution.

Compliance incentives and behaviour

• The SoP incentivises claimants to assemble detailed and temporally precise clinical and lifestyle evidence. Because many factors impose numerical thresholds (e.g. BMI ≥25 for five years, 200 g alcohol/week for one year, five pack‑years, 5,000 hours of second‑hand smoke), claimants will need medical records, GP notes, employment histories, support statements, and sometimes quantitative corroboration (for example, occupational exposure records) to satisfy the SoP. This is an indirect enforcement mechanism: the SoP channels evidentiary behaviour because meeting its thresholds is the path to a prima facie case.

Risks of inconsistent application

• The SoP leaves several terms operationally undefined, which creates interpretive discretion for decision‑makers (for example, “clinical onset”, “clinical worsening”, and “inability to obtain appropriate clinical management” are not defined in the Schedule). That undefined space may generate litigation over how those terms are applied in particular claims. The instrument itself contains no enforcement prescripts to standardise those interpretations; consistency depends on tribunal practice, administrative guidelines and medico‑legal evidence.

Record keeping and administrative costs

• No monetary penalties are imposed, but administrative and compliance costs are real. Claimants and advisers must compile histories that meet strict temporal and quantitative elements; decision‑makers must evaluate those materials against the SoP and potentially against other SoPs per s11. The instrument centralises definitional and threshold disputes into the adjudication process rather than imposing direct sanctions.

Primary statutory relationships contained in the instrument

• Made under VEA subsection 196B(2): the SoP is expressly made under subsection 196B(2) of the Veterans' Entitlements Act 1986 (s3). That locates the instrument within the VEA’s SoP framework and signals that it is the RMA’s Statement of Principles for psoriasis.
• Application to VEA and MRCA claims: the SoP applies to claims to which s120A of the VEA or s338 of the MRCA applies (s5). Thus the SoP is an evidentiary instrument for two statutory claim streams: veterans’ entitlements under VEA and military rehabilitation and compensation under MRCA.

Cross‑Statement interaction

• Section 11 requires that if a factor in this SoP refers to an injury or disease that is the subject of another SoP determined under subsection 196B(2) of the VEA, then that other SoP applies according to its own terms. This creates a hierarchical or cross‑referential architecture among SoPs: where comorbidity or a named disease overlaps, decision‑makers must apply the specialist SoP applicable to that co‑disease. The effect is to channel detailed causation questions about comorbid diseases into the SoP that deals with them.

Interaction with diagnostic coding standards

• The SoP references ICD‑10‑AM codes for psoriasis (s7(3)-(4)) and specifies the edition and effective date of the coding set (Tenth Edition, effective date 1 July 2017). It therefore anchors one element of its applicability to a specific edition of an external diagnostic coding standard. Decision‑makers should be attentive to whether medical records use different coding editions or lay descriptions; the SoP nevertheless takes the clinical definition in s7(2) as its operative meaning.

Overlap with other statutory criteria

• The SoP sets a minimum threshold (reasonable hypothesis) for causation, but entitlement and benefits are governed by the VEA and MRCA statutory frameworks, which are not reproduced in this instrument. The SoP must be read and applied in conjunction with statutory tests and procedures under those Acts (s3 and s5 indicate the interconnection). The SoP does not change the substantive entitlements under the VEA/MRCA; it establishes the RMA’s medical‑scientific view on causation to be used when applying those Acts.

Administrative law and evidentiary processes

• As an administrative instrument, the SoP will be part of the evidentiary matrix in adjudication and in any merits or judicial review proceedings that follow adjudicative decisions. Although the SoP records the RMA’s medical view (s8), it does not preclude decision‑makers or tribunals from considering other medical evidence; rather, it provides the standard for what raises a reasonable hypothesis. The SoP itself does not prescribe appeal routes; those routes are in the parent statutes.

Interaction with medical practice and records law

• The SoP’s reliance on specific temporal and quantitative thresholds makes medical record completeness and historical social history critically relevant. Practitioners and record custodians should note the operative definitions (for example, BMI formula, pack‑year calculations using 7,300 grams equivalence, and what constitutes being exposed to second‑hand smoke) in the Schedule when preparing or producing records for claims (Schedule).

Requirement to check for amendments/uncommenced provisions

• The compilation notes that uncommenced amendments will not appear in the text and directs users to the Legislation Register (compilation preamble). Practitioners must therefore check for later amendments or uncommenced changes to the SoP or to the definitions used (s7(3)-(4) and the endnotes recording amendment No. 94 of 2022).

Amendments recorded in the compilation

• The compilation date is 19 September 2022 and it includes amendments up to the Veterans' Entitlements (Statements of Principles,definition of "one pack‑year") Amendment Determination 2022 (No. 94 of 2022) (F2022L01128). The compilation notes that the day of commencement of that Amendment Determination is 19 September 2022 (compilation preamble and endnotes).

Specific amendment entries in the endnotes

• Endnote 3 (Legislation history) records the original Statement of Principles concerning psoriasis (No. 13 of 2021) with registration on 4 January 2021 and commencement 25 January 2021.
• The Amendment Determination No. 94 of 2022 is recorded with registration on 26 August 2022 and commencement 19 September 2022 (endnote 3).
• Endnote 4 (Amendment history) indicates how the provisions were affected. It shows that the notes to subsections 9(12) and 9(27) were revised by the 2022 Determination, and that the Schedule 1 - Dictionary entry for one pack‑year was revised by the 2022 Determination (endnote 4).

Nature of the 2022 amendment

• The core change shown in the compilation concerns the definition and explanatory notes for “one pack‑year” (Schedule) and related notes in subsections 9(12) and 9(27) that reference pack‑years. The amended Schedule defines one pack‑year as the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products, and then supplies equivalence metrics: 7,300 grams of smoking tobacco per year as equivalent (Schedule, one pack‑year; endnote 4). The amendment therefore added or clarified the weight equivalence and methods for calculating pack‑years where non‑cigarette forms of tobacco are involved (Schedule; endnote 4).

How the compilation treats amendments

• The preamble explains that the compilation shows the law as amended and in force on 19 September 2022. It notes that uncommenced amendments are not shown and points to the Legislation Register for any uncommenced amendments. The endnotes provide more granular amendment history and the amendment table in endnote 4 summarises which specific provisions were altered by the 2022 Determination.

Practical consequence of the amendments

• The 2022 amendment clarifies the pack‑year metric used in s9(12) and s9(27) and may affect how smoking exposure is calculated in claims. Because pack‑years are an evidentiary threshold in the SoP (s9(12) and s9(27) require at least five pack‑years), the clarified equivalence for non‑cigarette tobacco forms and the example calculations included in the Schedule change how historical tobacco use is converted into the pack‑year metric for claim purposes.

Check for further changes

• The compilation warns users to check the Legislation Register for uncommenced amendments or subsequent modifications not shown in the text. Practitioners should confirm that no further amendments to definitions (for example, for BMI or second‑hand smoke hours) have been made after 19 September 2022.

No litigation or case references provided in the instrument

• The instrument itself contains no references to case law, judicial decisions or administrative appeals. It names no cases. The compilation’s endnotes list only legislative amendment history; they do not record litigation (endnotes 3 and 4).

Implications of absence of litigation references

• Because the instrument is a statutory SoP rather than a judicial decision, any litigation arising from its application will be found in later administrative or judicial records, not within the SoP itself. The SoP’s text does not indicate any tribunal or court rulings that interpret its definitions or application. Practitioners should therefore search tribunal and court records (for example decisions under the VEA/MRCA, Veterans’ Review Board or AAT and courts) for post‑2021 interpretations, but such searches fall outside the content of this document.

How to treat the lack of on‑point authority

• In the absence of judicial guidance contained within the instrument, decision‑makers and advisers must rely on the instrument’s textual definitions and on medico‑scientific evidence when forming or contesting a reasonable hypothesis. Areas lacking statutory clarity (for example, undefined terms such as “clinical onset”, “clinical worsening” and “inability to obtain appropriate clinical management”) are potential loci for future litigation, so careful evidence and clear medico‑legal opinions will be important to avoid uncertainty.

Where to look for litigation developments

• The SoP’s preamble points readers to the Legislation Register for amendments. For litigation history, practitioners should consult decisions under the VEA and MRCA regimes (Veterans’ Review Board, AAT, Federal Court) and tribunal databases. This SoP compilation contains no litigation entries; it records only legislative history (endnotes).

Terms that the SoP leaves undefined or that invite interpretive discretion

• “Clinical onset” and “clinical worsening”: the SoP repeatedly uses these phrases (for example, s9(1), s9(2), s9(16), s9(17)) but does not define them in the Schedule. That absence means practitioners must define these clinically in each claim and rely on contemporaneous clinical records or expert opinion. Expect disputes about when onset or worsening actually occurred.
• “Inability to obtain appropriate clinical management” (s9(30)) is not defined. This term will require factual proof showing attempts to obtain care, the reasons for non‑receipt, and linkage to worsening. It leaves significant administrative discretion and will be a likely focus for contest.

Numeric thresholds that require precise evidence

• Second‑hand smoke exposure threshold: the SoP requires at least 5,000 hours of enclosed‑space exposure to second‑hand smoke (s9(13) and s9(28); Schedule). Practically, proving 5,000 hours (more than half a year of continual exposure; if 8 hours/day, ~625 working days) is challenging and often relies on employment or housing histories that document enclosed‑space exposure. The Schedule defines second‑hand smoke exposure as inhaling smoke in an enclosed space from burning tobacco or exhaled smoke of another,this definition excludes casual outdoor exposures but requires proof of enclosed environments.
• Alcohol: an average of at least 200 grams of alcohol per week for at least one year (s9(6) and s9(21)) translates to an average of 20 standard drinks per week using the Australian standard definition of 10 grams per drink (s9 notes). That is a high threshold requiring credible longitudinal alcohol histories.
• BMI duration and threshold: “being overweight or obese” requires a BMI of 25 or greater sustained for at least five years before clinical onset/worsening (s9(14) and s9(29); Schedule). This demands longitudinal weight and height records; a single BMI reading is unlikely to satisfy the five‑year requirement.

Smoking metrics and unusual equivalence rules

• “One pack‑year” is defined as smoking 20 cigarettes per day for one year, or an equivalent amount of tobacco products, with a specific weight equivalence of 7,300 grams per year for smoking tobacco (Schedule, one pack‑year). The Schedule treats 1 gram of tobacco as equal to one cigarette for pipe tobacco or cigars. These conversion rules may be unfamiliar and require careful documentary work to convert non‑cigarette tobacco use into pack‑years.

Specified list of drugs: breadth and timing

• The schedule’s “specified list of drugs” includes many classes and named drugs (ACE inhibitors, beta‑blockers, bupropion, chloroquine, hydroxychloroquine, lithium, tetracyclines, terbinafine, itraconazole, antimalarials, docetaxel, apixaban, biologic agents and others). Many of these drugs have varied usage patterns and indications. The SoP requires at least seven days’ continuous exposure to a listed drug before clinical onset or worsening (s9(2), s9(17), s9(3), s9(18) where improvement after discontinuation also matters). Claimants and advisers must therefore identify precise drug exposure histories, including start/stop dates and any tapering or withdrawal details.
• Drug withdrawal windows: withdrawal from tumour necrosis factor‑α inhibitor treatment within six months before clinical onset or worsening (s9(4) and s9(19)), and withdrawal from systemic or certain topical glucocorticoids within 30 days before clinical onset or worsening (s9(5) and s9(20)) are included as factors. Proof requires documentation of cessation dates, treatment tapering regimens and clinical responses after stopping therapy.

Stressors: categories, timelines and exclusions

• Stressors are categorised (1A, 1B, 2) in the Schedule with specific event types. For example, category 1A includes life‑threatening events and serious physical attack/assault, category 1B includes killing or maiming a person and being an eyewitness to atrocities, and category 2 captures chronic negative life events such as social isolation, relationship breakdown, workplace problems, major financial hardship and caregiver burden (Schedule). The SoP requires these stressors to have occurred within six months before clinical onset or worsening (s9(7)-(9), s9(22)-(24)).
• The Schedule excludes exposure via public broadcasting or media from the definition of eyewitness and defines “corpse” in a narrow way that excludes closed body bag or viewing a body in an open coffin. Those detailed exclusions can materially affect whether particular reported stressors qualify.

Cross‑SoP application traps

• If a factor refers to a disease covered by another SoP, that other SoP applies (s11). Practitioners must check whether comorbid conditions invoked by a factor (for example, Streptococcus pyogenes infection) have their own SoPs that supply different temporal windows or definitions.

Death from psoriasis requires contribution to terminal event

• A death is within the SoP only if death from a terminal event or condition was contributed to by the person’s psoriasis (s7(5)). The Schedule defines “terminal event” by listing proximate causes (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). Establishing contribution to such terminal events will require clinical records showing psoriasis’ role in the terminal chain.

Administrative practicalities

• The SoP adopts the ICD‑10‑AM codes effective 1 July 2017 Tenth Edition (s7(4)). If medical records use more recent editions or different coding systems, practitioners must map the clinical descriptions to the SoP’s operative definition in s7(2).
• Subsections 9(16)-9(30) apply only to material contribution or aggravation where psoriasis predated or occurred during service but did not arise out of service (s10(2)). Distinguishing “arose out of” service versus being “suffered or contracted before or during” service will be a contested fact in some files.

Checklist for advisers assembling a claim or preparing a medical opinion

1. Confirm applicability of the SoP

   • Verify the claim falls under s120A of the VEA or s338 of the MRCA (s5). If the claim is outside those statutory provisions, this SoP will not apply.

2. Establish the clinical diagnosis using the SoP’s operative definition

   • Use the clinical definition in s7(2) to confirm psoriasis (keratinocyte hyperproliferation with erythematous plaques, patches and papules). While ICD‑10‑AM codes are noted (s7(3)-(4)), the instrument emphasises the clinical definition. Ensure dermatology notes and histology, if available, record features consistent with s7(2).

3. Date the “clinical onset” and/or “clinical worsening”

   • Because “clinical onset” and “clinical worsening” are not defined in the Schedule, documentary clarity is critical. Obtain contemporaneous clinical notes, specialist letters, hospital records and GP records that place the timing of first symptoms and any subsequent worsening. If timing is ambiguous, obtain a detailed expert opinion that defines onset/worsening with reference to the medical records.

4. Identify at least one qualifying factor from s9 with required timing/threshold

   • Systematically assess each s9 factor and its required timing:
     • Skin injury/lesion within 30 days before onset/worsening (s9(1), s9(16)).
     • Drug exposure from the specified list for at least seven days before onset/worsening (s9(2), s9(17)) , document start/stop dates and prescription records; check the Schedule for the specified list of drugs.
     • Drug‑associated development and improvement on withdrawal within two months where drug therapy continued for at least seven days (s9(3), s9(18)).
     • Withdrawal from tumour necrosis factor‑α inhibitors within six months (s9(4), s9(19)).
     • Withdrawal from systemic or certain topical glucocorticoids within 30 days (s9(5), s9(20)); consult Schedule for high/moderate potency topical glucocorticoids definitions.
     • Alcohol: average ≥200 g/week for at least one year before onset/worsening (s9(6), s9(21)); convert reported consumption using 10 g per standard Australian drink.
     • Stressors: category 1A/1B/2 events within six months (s9(7-9), s9(22-24)); map reported events to the Schedule categories and collect corroborating records.
     • Streptococcus pyogenes infection within 30 days (s9(10), s9(25)).
     • HIV infection before onset/worsening (s9(11), s9(26)).
     • Smoking: at least five pack‑years before onset/worsening (s9(12), s9(27)); use the Schedule’s pack‑year definition and conversion (post‑2022 amendment) to convert non‑cigarette tobacco use to pack‑years.
     • Second‑hand smoke: at least 5,000 hours of enclosed‑space exposure (s9(13), s9(28)); document employment, housing and other enclosed‑space exposure histories.
     • Overweight/obese (BMI ≥25) sustained for at least five years (s9(14), s9(29)); collate weight/height records across the period to demonstrate sustained BMI.
     • For impetigo herpetiformis: pregnancy within six weeks before onset (s9(15)).
     • Inability to obtain appropriate clinical management for psoriasis (s9(30)); document attempts to access care and barriers (referrals, waitlists, refusals, geographic access).

5. Link the qualifying factor to relevant service

   • The SoP requires that the factor be related to relevant service (s10(1)). Collect evidence tying the factor to service circumstances. Examples: a service‑related skin injury, documented service exposure to second‑hand smoke, deployment circumstances that led to stressors (and contemporaneous reports), service‑administered medications, or infections acquired in service. The SoP does not specify evidentiary form for the service linkage; contemporaneous service records, unit logs, clinical entries in the service medical record, and witness statements are the usual evidence.

6. If psoriasis pre‑existed service, apply the aggravation rules

   • If the psoriasis was suffered or contracted before or during but did not arise out of service, use subsections 9(16)-9(30) which govern material contribution or aggravation, and be mindful that these factors only apply in that material contribution/aggravation context (s10(2)).

7. Check cross‑SoP references

   • If a factor invokes another disease covered by a different SoP (for example a particular infection), identify and apply the other SoP as required by s11. This may change timing windows or definitions relevant to that disease.

8. Prepare or obtain a focussed medico‑legal/clinical opinion

   • A medical expert should link the clinical diagnosis, the timing of onset/worsening, the presence of the specified factor, and the relationship of that factor to relevant service. Because the SoP establishes a minimum threshold for a reasonable hypothesis, the medico‑legal opinion should explicitly state whether the SoP’s factor(s) are present and related to service, referencing the precise provisions (for example s9(4) withdrawal from TNF‑α inhibitors within six months).

9. Address death cases specifically

   • For death claims, gather evidence that psoriasis contributed to the terminal event listed in the Schedule (pneumonia, respiratory failure, cardiac arrest, circulatory failure or cessation of brain function) and explain the contribution path (s7(5); Schedule, terminal event).

10. Document conversions and calculations

    • Convert tobacco use to pack‑years using the Schedule’s definitions (including the weight equivalence and examples) post‑2022 amendment.
    • Convert alcohol consumption to grams per week using the Australian standard (10 g/drink) as the SoP’s note instructs (s9(6) and s9(21)).
    • Calculate BMI consistently using the Schedule formula BMI = W/H2 and document measurements across the required five‑year period (Schedule).

11. Anticipate common evidentiary challenges

    • Expect disputes about onset/worsening dates, and amount/duration thresholds for alcohol, smoking and second‑hand smoke exposure. Collect corroborating employment, housing, duty logs and contemporaneous clinical entries.
    • For the stressor categories, map events precisely to the Schedule definitions and obtain corroborative evidence (service reports, police records, witness statements).

12. Keep the SoP edition current

    • Because the compilation warns that uncommenced or later amendments may not be in the document, check the Legislation Register and RMA publications for any subsequent amendments or replacement SoPs. The compilation notes the 2022 amendment (endnotes 3 and 4) and instructs users to confirm uncommenced amendments on the Legislation Register.

Practical evidence sources to assemble

• Service medical records, deployment logs, unit incident reports.
• GP and specialist dermatology notes, pathology and histology, prescription and pharmacy dispensing records.
• Hospital admission and discharge summaries, infection test results (e.g. positive throat swabs for Streptococcus pyogenes).
• Prescriptions and treatment notes documenting biologic or tumour necrosis factor‑α inhibitor use and dates of withdrawal or tapering.
• Employment and housing histories documenting enclosed‑space second‑hand smoke exposure and hours.
• Weight and height measures across time (GP records, employer health checks) to document five‑year BMI history.
• Alcohol history recorded in clinical notes or corroborated by family statements or employment medicals.
• Smoking histories and tobacco purchase records where available; convert to pack‑years using the Schedule rules.
• Records evidencing attempts to obtain clinical management if relying on s9(30).

Timeliness and procedural notes

• Assemble the SoP‑related evidence early in the claim process so that the initial decision‑maker can apply the SoP factors at the “reasonable hypothesis” stage. Given that the SoP establishes a minimum threshold rather than a final entitlement, early medico‑legal clarification of whether the SoP is satisfied will streamline decision‑making and reduce the risk of later rework.

Document drafting tips for medical opinions

• State clearly which SoP factor(s) are relied upon and cite the exact subsection(s) (for example, “s9(4): withdrawal from tumour necrosis factor‑α inhibitor within six months”).
• Define the date of clinical onset/worsening with references to records and explain how that date was determined clinically.
• Translate lifestyle metrics into the SoP’s required measures (grams/week of alcohol; pack‑years; BMI sustained for five years; hours of second‑hand smoke exposure).
• If cross‑SoP factors are invoked, identify the other SoP and explain which provisions are being invoked pursuant to s11.

This procedural approach reduces uncertainty about how the SoP will be applied, converts qualitative clinical histories into the quantifiable thresholds the instrument demands, and anticipates the particular evidentiary hurdles created by the instrument’s definitions and windows.