Statement of Principles concerning relapsing polychondritis (Reasonable Hypothesis) (No. 13 of 2026)

This instrument is a Statement of Principles (SoP) made by the Repatriation Medical Authority (RMA) about relapsing polychondritis and death from relapsing polychondritis. It is numbered No. 13 of 2026, dated 19 December 2025 and it commences on 19 January 2026 (see Name and Commencement). The RMA made it under subsection 196B(2) of the Veterans' Entitlements Act 1986 (VEA) (see Authority). The Statement repeals the earlier SoP concerning relapsing polychondritis (No. 5 of 2017), Federal Register of Legislation No. F2017L00006 (see Repeal).

Mechanically, the instrument does three discrete things. First, it sets the medical definition to be used for the purposes of VEA and Military Rehabilitation and Compensation Act 2004 (MRCA) claims: relapsing polychondritis is defined as a systemic autoimmune disease characterised by episodic, progressive inflammatory destruction of cartilaginous structures and connective tissue throughout the body, predominantly affecting ears, nose, eyes, joints and respiratory tract (see subsection 7(2)). The instrument also notes the ICD‑10‑AM code M94.1 as the code that attracts to relapsing polychondritis, while making clear the statutory meaning is the textual definition in subsection 7(2) rather than the code alone (see subsection 7(3)).

Second, it identifies the causal threshold and the factual factor that must be present to raise a reasonable hypothesis that the condition is related to relevant service for VEA s120A or MRCA s338 claims. The RMA states that there is sound medical‑scientific evidence that relapsing polychondritis and death from it can be related to relevant service (see Basis for determining the factors). As the minimum factual requirement, the SoP lists one factor: inability to obtain appropriate clinical management for relapsing polychondritis before clinical worsening (see section 9(1)). The instrument then limits how that factor can operate in service‑linking: it applies only to material contribution to, or aggravation of, relapsing polychondritis where the condition was suffered or contracted before or during, but did not arise out of, the person's relevant service (see section 10(2)). Third, the instrument explains that if a factor refers to an injury or disease already covered by another SoP, then the factors in that other SoP apply in accordance with its terms (see section 11).

Practically, the SoP is an evidentiary standard used in claims adjudication under the VEA and MRCA; it does not itself create a new compensation right or prescribe penalties. It specifies the medical description and the minimum factual connection needed to raise a reasonable hypothesis that relapsing polychondritis (or death from it) is related to relevant service (see sections 7-11 and Schedule 1 for defined terms such as relevant service and terminal event).

The instrument operates as an RMA Statement of Principles under subsection 196B(2) of the VEA (see Authority). Its core concepts and their statutory anchors are as follows.

Relapsing polychondritis (RP): the instrument defines RP substantively in subsection 7(2) as a systemic autoimmune disease with episodic, progressive inflammatory destruction of cartilage and connective tissue, with predominant sites listed. The RMA also records the ICD‑10‑AM code M94.1 as the coding reference (subsection 7(3)), but the definition for the purpose of the SoP is the textual description in subsection 7(2). The Schedule repeats that relapsing polychondritis,see subsection 7(2).

Death from relapsing polychondritis: the SoP treats death from RP as included where the death is from a terminal event or condition that was contributed to by the person’s RP (see subsection 7(4)). The Schedule defines terminal event as the proximate or ultimate cause of death and lists examples such as pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (Schedule 1).

Relevant service: the instrument applies to claims to which VEA s120A or MRCA s338 applies (see Application). The Schedule 1 defines "relevant service" by reference to categories in the VEA and MRCA: operational service, peacekeeping service, hazardous service, British nuclear test defence service under the VEA, and warlike or non‑warlike service under the MRCA. That definition is pivotal because the causal nexus the SoP assesses is between RP (or death from RP) and those forms of service (Schedule 1).

Causal standard and minimal factor: the RMA states it is of the view that sound medical‑scientific evidence indicates RP and death from RP can be related to relevant service (Basis for determining the factors). To raise a reasonable hypothesis of connection, at least one factor must exist , the SoP contains a single minimum factor: inability to obtain appropriate clinical management for RP before clinical worsening (see section 9(1)). The connection between that factor and relevant service must itself be demonstrated; the instrument requires the existence of a factor to be related to the person's relevant service (see section 10(1)).

Temporal and causal limitation: subsection 10(2) limits the operation of s9(1): that factor applies only to material contribution to, or aggravation of, RP where the person’s RP was suffered or contracted before or during (but did not arise out of) the person's relevant service. That is a specific temporal/causal cut; the SoP therefore draws a distinction between RP that pre‑existed or was present during service but did not arise out of it, and conditions that did arise out of service.

Primary affected parties identified in the instrument are:

• Veterans, members of Peacekeeping Forces, or members of the Forces to whom the VEA applies; and members covered under the MRCA where s338 applies. The instrument says it applies to a claim to which section 120A of the VEA or section 338 of the MRCA applies (see Application). That is the statutory gate: anyone bringing a claim under those provisions may have this SoP applied in their claim assessment.

• Decision bodies that adjudicate VEA and MRCA claims. The SoP is issued under subsection 196B(2) of the VEA (see Authority). While the instrument itself does not name adjudicators, SoPs are instruments that decision‑makers administering the VEA and MRCA will apply as the medical standard for raising a reasonable hypothesis. The RMA is the issuing body; the RMA’s view about sound medical‑scientific evidence is recorded in the instrument (see Basis for determining the factors).

• Medical practitioners and expert witnesses who provide evidence for claims. The SoP prescribes the medical description of relapsing polychondritis to be used in claims (see subsection 7(2)), notes the relevant ICD‑10‑AM code (subsection 7(3)), and specifies what factor must exist to raise a reasonable hypothesis (section 9). Medical evidence will therefore be expected to address those textual elements: diagnosis according to the SoP definition, timing of disease onset in relation to service, whether appropriate clinical management was unavailable prior to clinical worsening, and whether death (where applicable) involved a terminal event to which RP contributed (subsection 7(4) and Schedule 1 definition of terminal event).

• Departments and agencies processing claims. The Department administering veterans’ entitlements will need to apply this SoP for relevant claims from 19 January 2026, and to understand how it interacts with other SoPs where cross‑references exist (section 11). The instrument repeals the 2017 SoP, so agencies must replace the earlier instrument in procedural materials (see Repeal).

• Parties with concurrent conditions. The instrument specifically contemplates instances where a factor refers to another injury or disease covered by a different SoP; in those cases the other SoP’s factors apply as in force (section 11). That will affect claimants whose RP interacts with other conditions and may require multiple SoPs to be considered.

Less directly affected are providers of clinical management and health services. The minimal factor in section 9(1) is inability to obtain appropriate clinical management prior to clinical worsening. That factor centres access to care: the existence or absence of timely, appropriate clinical management is the factual hinge for the reasonable hypothesis. Accordingly, evidence about availability or denial of appropriate treatment, wait times, geographic access, and other measures of "ability to obtain" will be material to claims adjudicated using this SoP.

The Statement of Principles is not drafted as a code of statutory duties or rights in isolation. It is an evidentiary instrument that identifies the medical description and the facts required to raise a reasonable hypothesis that relapsing polychondritis (RP), or death from RP, is related to relevant service. Key legal positions and practical duties or rights that follow from the instrument, as grounded in the text, are:

Duty of RMA to issue SoP under VEA authority: the instrument records that it is made under subsection 196B(2) of the VEA (see Authority). That identifies the statutory power the RMA used to make the SoP. The instrument itself stands as the RMA's determination of factors for RP.

Duty of decision‑makers to apply the SoP (implicit): the SoP is framed to be applied in claims under VEA s120A and MRCA s338 (see Application). While the instrument does not explicitly state the procedural duty of decision‑makers, its structure and placement under VEA indicate it is to be used as the medical‑scientific statement for assessing causation in claims covered by those provisions. Decision‑makers must consider the SoP’s factors when determining whether a reasonable hypothesis exists that RP is related to relevant service.

Claimant evidentiary burden: the SoP specifies the minimal factual factor that must exist to raise a reasonable hypothesis: inability to obtain appropriate clinical management for RP before clinical worsening (see section 9(1)). For a claimant to rely on this SoP in a claim under VEA s120A or MRCA s338, evidence must be produced that demonstrates that this factor occurred and that it is related to the person’s relevant service (see section 10(1)). The claimant will therefore need to present evidence about access to and appropriateness of clinical management and timing relative to clinical worsening.

Temporal limitation on the factor: subsection 10(2) limits the operation of s9(1) to circumstances where RP was suffered or contracted before or during but did not arise out of relevant service. This creates a right/limit dynamic: the SoP enables a claim via the inability‑to‑obtain‑management factor only in the particular temporal/causal scenario described. Where RP arose out of relevant service, that factor does not apply under subsection 10(2).

Interaction duty when other SoPs are implicated: section 11 requires that if a factor in this SoP refers to an injury or disease covered by another SoP, then those other SoP factors apply in accordance with their terms. Decision‑makers and claimants have the practical duty to identify and apply those other SoPs as part of an integrated assessment.

The Statement of Principles does not create criminal or civil penalties, nor does it prescribe an enforcement regime within its text. It is an evidentiary instrument issued under subsection 196B(2) of the VEA (see Authority) for application in claims under VEA s120A or MRCA s338 (see Application). The instrument sets medical‑scientific factors that must exist to raise a reasonable hypothesis that relapsing polychondritis (or death from it) is related to relevant service; it does not include provisions creating offences, monetary penalties, enforcement agencies, or administrative sanctions.

Practical enforcement consequences are therefore indirect and arise through the claims process under the VEA and MRCA rather than through this SoP itself. By describing the medical definition and the minimal factor required (inability to obtain appropriate clinical management before clinical worsening, see section 9(1)) and by specifying limits on its operation (see section 10(2)), the SoP affects how decision‑makers assess causation. The practical consequence of failing to satisfy the SoP's factors is that a decision‑maker may not accept that a reasonable hypothesis of service connection has been raised for the purposes of a VEA or MRCA claim. The instrument does not, however, specify appeal rights, review mechanisms, or procedural remedies; those remain within the VEA/MRCA frameworks not reproduced in this SoP.

There is no mention in the text of delegated enforcement powers, inspection, audit, or mandatory reporting obligations arising from the SoP itself. The RMA records its view that "there is sound medical‑scientific evidence" indicating RP and death from RP can be related to relevant service (Basis for determining the factors), but that is a statement of the RMA's expert determination and not an enforcement provision.

Where a factor in this SoP refers to an injury or disease covered by another Statement of Principles, section 11 requires application of that other SoP in accordance with its terms. If the other SoP contains procedural or evidentiary directives, those will have their own enforcement or practical consequence context; however, those are external to this instrument and are not described here.

In short, this document functions as a technical, medical evidentiary tool for claims adjudication. It does not itself impose penalties or an enforcement regime, and any adverse consequences for a claimant arise from how the SoP is applied within the established VEA and MRCA claims processes.

This Statement of Principles explicitly situates itself within the VEA/MRCA legislative frameworks. The instrument is made under subsection 196B(2) of the VEA (see Authority) and it states that it applies to claims to which VEA s120A or MRCA s338 applies (see Application). Those two statutory references are the cross‑reference points that bind the SoP to the rights and procedures established in the VEA and MRCA, even though the precise adjudicative mechanics of those Acts are not reproduced in this instrument.

Definitions and cross‑references: Schedule 1 defines key terms used for interaction with other legislation. "Relevant service" is defined by reference to service categories contained in the VEA and the MRCA: operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike or non‑warlike service under the MRCA (Schedule 1). Those definitions determine the class of service events that can be the comparator for establishing a relationship under the SoP.

ICD coding reference: subsection 7(3) references The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD‑10‑AM), Tenth Edition, effective 1 July 2017 and copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑296‑4. The instrument notes that while RP attracts ICD‑10‑AM code M94.1, the statutory meaning used in the SoP is the definition in subsection 7(2). That creates an interaction between the textual statutory definition and an external clinical classification system: decision‑makers and clinicians may use the ICD code for administrative classification but must interpret RP for causal assessment by reference to the SoP definition.

Interaction with other Statements of Principles: section 11 provides an explicit mechanism to link this SoP to other SoPs. If a factor in this SoP refers to an injury or disease covered by another SoP determined under VEA s196B(2), then those other SoP factors "apply in accordance with the terms of that Statement of Principles as in force from time to time" (section 11). That means a claim may require concurrent application of multiple SoPs and that the current terms of other SoPs, including amendments, will govern the related condition. Practically, this produces layered interaction where a claimant and decision‑maker must identify all relevant SoPs and apply them according to their current terms.

Temporal interaction with service law: subsection 10(2) creates an interaction between medical facts and the statutory concept of relevant service. It limits s9(1) to situations where RP was suffered or contracted before or during, but did not arise out of, the person's relevant service. That produces a boundary where RP arising out of relevant service is not to be connected to the inability‑to‑obtain‑management factor prescribed in s9(1). The instrument does not state how RP that arises out of service should be assessed; that outcome may rely on other parts of the VEA/MRCA or other SoPs.

The instrument sets out a minimal amendment history within its text. It is designated as the Statement of Principles concerning relapsing polychondritis (Reasonable Hypothesis) (No. 13 of 2026) and is dated 19 December 2025 with commencement on 19 January 2026 (see Name and Commencement). The Repatriation Medical Authority made the instrument under subsection 196B(2) of the Veterans' Entitlements Act 1986 (see Authority).

The document expressly repeals the earlier Statement of Principles concerning relapsing polychondritis (Reasonable Hypothesis) (No. 5 of 2017), Federal Register of Legislation No. F2017L00006 (see Repeal). That is the only repeal or amendment recorded within this instrument. No other amendments, schedules of transitional provisions, or savings clauses appear in the text provided.

Because the instrument refers to other Statements of Principles "as in force from time to time" (section 11), it anticipates that other SoPs may be amended independently; those subsequent amendments would interact with this SoP by reference. The instrument therefore forms part of a mutable network of RMA SoPs: it is fixed at the date it is made for its own terms, but it incorporates the terms of other SoPs as they may be amended later where cross‑references exist.

The instrument also references the ICD‑10‑AM (Tenth Edition, effective date 1 July 2017) by ISBN and copyright holder (subsection 7(3)). That citation fixes a particular edition of the ICD‑10‑AM for descriptive purposes. The instrument does not specify how future editions or updates to ICD‑10‑AM would affect the SoP; it simply states the current edition that was used as the coding reference when the SoP was made.

No other amendment history, prior drafts, consultation statements, or modifications are included in the text provided. The practical implication is that, from its commencement date, this SoP supplants the 2017 SoP on relapsing polychondritis for claims falling within its scope, and further alterations to related SoPs or to the parent Acts would affect its application insofar as cross‑references require.

The Statement of Principles document provided contains no record of litigation history. It does not cite any judicial decisions, tribunals, or authoritative case law; it names only the Repatriation Medical Authority and records its view that there is sound medical‑scientific evidence that RP and death from RP can be related to relevant service (see Basis for determining the factors). The instrument does not identify any legal challenges to prior SoPs or to the RMA's determinations.

Because the document is an administrative instrument setting out medical criteria for use in claims under the VEA and MRCA, litigation arising from its application would take place in forums that adjudicate decisions under those Acts. However, no such proceedings, outcomes, or citations are recorded in the text provided.

Where a factor in this SoP refers to another injury or disease covered by another SoP, section 11 requires application of that other SoP "as in force from time to time". Any litigation about the interpretation or application of those other SoPs would be external to this instrument and is not documented here.

Practically, the absence of litigation references in the instrument means readers seeking precedent on how courts or tribunals have interpreted equivalent RMA SoPs, the reasonable‑hypothesis test, or the particular factor listed here will need to consult the case law databases or decisions arising under the VEA or MRCA. Those sources are outside this instrument. The SoP itself stands as the RMA’s statement of the relevant medical‑scientific basis as at the date of signing.

This instrument is short and specific, and its concision produces several practical traps and interpretative points that parties must notice. The SoP’s operational effect is concentrated in a few provisions; failure to attend to their detail can produce adverse claim outcomes.

Single minimal factor: the SoP lists only one minimal factor that must exist to raise a reasonable hypothesis: "inability to obtain appropriate clinical management for relapsing polychondritis before clinical worsening" (section 9(1)). That is a narrow, outcome‑linked factual element. A claimant who cannot produce evidence relating specifically to inability to obtain appropriate clinical management, or who frames their causal argument in other terms (for example, exposure at a particular location, or a different treatment failure narrative), risks failing to meet the minimal factor specified. The SoP does not list multiple alternative factors that might be accepted for RP; if the claimant’s evidence does not speak directly to this factor, the SoP may be of limited assistance.

Temporal/causal limitation in s10(2): the factor in s9(1) "applies only to material contribution to, or aggravation of, relapsing polychondritis where the person's relapsing polychondritis was suffered or contracted before or during (but did not arise out of) the person's relevant service" (section 10(2)). That is a key limitation. If the claimant’s RP arose out of relevant service (the SoP does not define "arise out of" inside its text), then s9(1) does not apply. Practitioners should not assume the inability‑to‑obtain‑management factor is relevant in claims that allege RP arose as a direct consequence of service; the SoP’s factor is configured for pre‑existing or present‑during conditions that were not caused by service.

Definition vs ICD code: subsection 7(3) states that while RP attracts ICD‑10‑AM code M94.1, the meaning of RP for the SoP is the textual definition in subsection 7(2). This avoids a mechanical reliance on coding alone. Medical evidence must engage with the clinical features set out in 7(2) rather than relying solely on an ICD code on a file. Conversely, administrative systems that filter by ICD code will need to ensure they map code usage to the SoP definition, not the code in isolation.

Death and terminal event scope: subsection 7(4) includes deaths where a "terminal event or condition" was contributed to by RP. The Schedule defines "terminal event" and gives specific examples. The inclusion requires a causal contribution of RP to a terminal event, not mere coincidence. Evidence linking RP as a contributor to the listed terminal causes will be necessary. A death where RP is incidental and did not contribute to a terminal event is outside the scope prescribed.

For claimants, treating practitioners and decision‑makers, compliance with the requirements and effective use of this Statement of Principles turns on aligning evidence to the SoP’s precise elements. The following are source‑grounded, practical steps derived from the instrument.

1. Confirm applicability to the claim: ensure the claim is one to which VEA s120A or MRCA s338 applies (see Application). If a claim does not fall within those provisions, this SoP does not apply.

2. Establish the diagnosis by reference to the SoP definition: medical evidence should address the clinical features set out in subsection 7(2) , that RP is a systemic autoimmune disease with episodic progressive inflammatory destruction of cartilaginous structures and connective tissue, predominantly affecting ears, nose, eyes, joints and respiratory tract. Do not rely on ICD‑10‑AM code M94.1 alone; the SoP states the statutory meaning is subsection 7(2) even though the code is noted (subsection 7(3)).

3. For death claims, connect RP to a terminal event: if the claim is for death from RP, provide evidence that the person’s RP contributed to the terminal event or condition listed as proximate or ultimate causes of death (see subsection 7(4) and the Schedule’s definition of terminal event, which includes pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function).

4. Prove the minimal factor: the SoP requires as a minimum the factor in section 9(1): inability to obtain appropriate clinical management for RP before clinical worsening. Evidence here should be specific and contemporaneous where possible. Useful documentary evidence might include medical records showing delays or absence of referrals, appointment logs, correspondence documenting service unavailability or refusals, specialist wait‑list information, contemporaneous clinician notes recording missed opportunities for appropriate management, and expert clinical reports tying the lack of management to subsequent clinical worsening.

5. Demonstrate relation to relevant service: section 10(1) requires that any factor relied upon must be related to the relevant service rendered. Evidence must show a link between the inability to obtain appropriate care and the person’s relevant service. For example, if service location, deployment, relocation, or restricted access during service is alleged to have caused inability to obtain appropriate management, produce documentary or testimonial evidence tying those facts to the access problem.