Statement of Principles concerning retinal vascular occlusion (Balance of Probabilities) (No. 51 of 2020)

The instrument centralises a few core legal‑medical concepts and ties them to evidentiary requirements. First, retinal vascular occlusion is specifically defined as an obstruction to blood flow in the retinal artery (or branches) or the retinal vein (or tributaries) leading to visual impairment, expressly excluding ischaemic optic neuropathy and ophthalmic artery occlusion (s 7(2)(a)-(b)). The instrument also notes common clinical features (painless, typically sudden vision loss, possible retinal ischaemia, macular oedema or neovascularisation, and transient monocular visual loss) (s 7(2) Notes).

Second, the instrument distinguishes two kinds of causal questions: (a) whether a listed factor existed before the clinical onset of retinal vascular occlusion and (b) whether a listed factor existed before the clinical worsening of an existing retinal vascular occlusion (compare s 9(1) and s 9(21) onward). The lists for onset and worsening are largely parallel, but each factor’s timing and legal consequence differ. Section 10(2) adds a legal gloss: the factors in subsections 9(21) to 9(41) apply only to material contribution to, or aggravation of, an already existing retinal vascular occlusion where the condition was suffered or contracted before or during, but did not arise out of, the relevant service.

Third, the concept of "relevant service" is defined in the Schedule (Schedule 1, relevant service), and the instrument is expressly limited to claims within the statutory scope of VEA section 120B and MRCA section 339 (s 5). The RMA’s standard of causation is stated in s 8 as "more probable than not" based on "sound medical‑scientific evidence", which is the RMA’s formulation of the balance of probabilities standard for medical causation in this context.

Fourth, the instrument lists discrete medical and non‑medical factors that the RMA regards as capable of connecting retinal vascular occlusion to service. These include chronic disease states (hypertension, diabetes mellitus, dyslipidaemia, hyperhomocysteinaemia), inflammatory and non‑inflammatory vascular disorders (retinal vasculitis, specified systemic arteritides, specified vasculopathies), hypercoagulable/hyperviscosity disorders, local ocular conditions (vascular abnormalities, neoplasms or mass lesions compressing vessels, open‑angle/angle‑closure glaucoma, ocular hypertension), systemic infectious states (HIV), traumatic or procedural events (blunt/penetrating injury, surgical positioning causing external ocular pressure, certain cardiac/carotid/intravascular procedures), drug exposure (specified drugs within 72 hours, and combined oral contraceptives for defined durations), and dehydration and chronic renal failure in relation to venous occlusion (s 9 and Schedule 1 definitions). Many factors include concrete temporal windows and objective diagnostic thresholds set out in the Schedule.

Fifth, the instrument contains cross‑reference rules to cover factors that overlap other Statements of Principles. Section 11 provides that where a factor refers to another injury or disease that itself has an SOP, the terms of that other SOP apply. This creates a layered framework where the RMA treats some conditions as governed by separate SOPs and requires decision‑makers to apply those SOPs "as in force from time to time" (s 11).

Finally, the Schedule contains precise definitions that the instrument uses as operational thresholds: one pack‑year, dyslipidaemia lipid thresholds, ocular hypertension (>21 mm Hg), chronic renal failure criteria (GFR <15 mL/min/1.73 m2 for at least three months, need for renal replacement therapy, or undergoing chronic dialysis), "being severely dehydrated" clinical signs, examples of specified lists (drugs, arteritides, vasculopathies), and a terminal event list relevant to deaths (Schedule 1). These definitional particulars are built into the causation checklist and determine how evidence is evaluated.

Primary affected persons are veterans, members of the Forces, or other persons who lodge claims that fall under section 120B of the Veterans' Entitlements Act 1986 or section 339 of the Military Rehabilitation and Compensation Act 2004, because the instrument expressly applies to claims to which those statutory sections apply (s 5). The Schedule defines "relevant service" categories that set the types of service qualifying under the instrument: eligible war service (other than operational service), defence service (other than hazardous service and British nuclear test defence service) under the VEA, and peacetime service under the MRCA (Schedule 1, relevant service).

Decision-makers who will use this instrument are administrative bodies and medical assessors (not named in the instrument) vested with responsibility under the VEA or MRCA to decide claims. The RMA, by issuing the Statement under s 3, supplies the medical framework that those decision-makers must use when evaluating whether retinal vascular occlusion (or death from it) is connected with service. The instrument does not itself grant benefits or direct payments; rather, it supplies the causation rules that inform entitlement decisions under the primary statutes (s 5 and s 8).

Medical practitioners supplying evidence for claims are affected in practice because the instrument demands specific clinical information and objective measures. Examples include quantified lipid levels to meet the dyslipidaemia thresholds in Schedule 1, documentation of glomerular filtration rate or dialysis to meet chronic renal failure criteria, intra‑ocular pressure measurements for ocular hypertension, verified dates and descriptions for injuries and procedures within specified temporal windows (for example, blunt or penetrating injury within seven days, direct external pressure lasting at least ten continuous minutes within 24 hours), and documentation showing smoking history sufficient to establish at least 20 pack‑years and the date of cessation (Schedule 1 definition of one pack‑year and s 9(1) and 9(21) notes).

Auxiliary affected parties include legal practitioners, claims managers, and forensic medical experts who must marshal evidence to satisfy the instrument’s criteria. The instrument creates evidentiary obligations: precise timing, objective lab and imaging results, records of procedures and drugs with accurate timing (for example, specified drugs within 72 hours; combined oral contraceptives used continuously for at least 21 days within the year before onset), and documentation of attempts to obtain clinical management where inability to obtain appropriate clinical management is relied upon (s 9(41)).

Finally, the instrument affects how overlapping conditions are treated through s 11: where a listed factor is itself an injury or disease covered by another Statement of Principles, the terms of that other SOP apply. Practitioners must therefore inspect the current suite of SOPs to ensure consistency and to identify which SOP provides the operative criteria for a referenced factor.

The Statement itself does not create duties in the criminal law sense. Instead, it creates administrative obligations and evidentiary rights by specifying medical factors the RMA regards as sufficient, on balance, to link retinal vascular occlusion to relevant service. Key legal requirements are these.

First, to give effect to the instrument a decision-maker considering a claim under VEA s 120B or MRCA s 339 must apply the factors listed in s 9 when assessing causation for retinal vascular occlusion. The instrument’s scope is asserted by s 5 and its medical‑scientific basis by s 8. The RMA’s determination is the source of those factors; practitioners and decision-makers must use that list when establishing causal connection.

Second, any factor that is relied upon must be related to the person’s relevant service (s 10(1)). That is, evidence must link the existence of the factor to what occurred during the person’s relevant service. Section 10(2) imposes an additional legal limitation for worsening claims: subsections 9(21) to 9(41) apply only to claims of material contribution or aggravation where the retinal vascular occlusion was suffered or contracted before or during, but did not arise out of, the relevant service.

Third, s 11 imposes a procedural duty of cross-application: if a factor in s 9 refers to an injury or disease governed by another Statement of Principles, then the other SOP applies "in accordance with the terms of that Statement of Principles as in force from time to time." This creates a requirement on claims preparers to locate and apply other SOPs (for example, those covering antiphospholipid antibody syndrome, or giant cell arteritis, if raised) and to ensure that the factors are established in the form required by those instruments.

Fourth, the Schedule’s definitions operate as normative evidential thresholds. For example, dyslipidaemia requires one of the listed laboratory thresholds or documentation of regular lipid-lowering therapy (Schedule 1, dyslipidaemia). Chronic renal failure is defined by GFR <15 mL/min/1.73 m2 for at least three months, requirement for renal replacement therapy, or undergoing chronic dialysis (Schedule 1, chronic renal failure). Ocular hypertension is defined as intra-ocular pressure greater than 21 mm Hg without optic atrophy or visual field loss (Schedule 1). One pack-year is precisely defined and includes a weight‑based conversion for pipe tobacco and cigars (Schedule 1). These definitional rules function as de facto evidentiary standards that practitioners must meet to demonstrate a listed factor exists.

Fifth, the RMA’s approach is explicitly probabilistic: the instrument is founded on the RMA’s view that it is "more probable than not" that retinal vascular occlusion can be related to relevant service (s 8). That establishes the balance of probabilities standard for causation, and indicates that the instrument is an evidentiary guide to meeting that standard in administrative determinations.

Rights implied by the instrument flow from the statutory claim processes rather than from the instrument itself. A claimant has the right to rely on any of the listed factors supported by appropriate evidence. Where a factor references another SOP, a claimant has the right to have that SOP applied per s 11. The instrument does not set review or appeal mechanisms; those rights are contained in the primary Acts and administrative law. The Statement does not create criminal or civil penalties; it is an evidentiary tool for administrative decisions.

This instrument contains no penalty provisions or criminal enforcement mechanisms. It is an administrative Statement of Principles that operates as the RMA’s medico‑legal framework to be applied to claims under VEA s 120B and MRCA s 339 (s 5 and s 8). The instrument does not itself impose fines, sanctions, or orders. Its operational effect is channelled through administrative decision-makers who apply the Statement when determining entitlement to veteran or service‑related benefits under the primary legislation.

Enforcement in practice is administrative adjudication. Decision-makers determining claims will assess whether the claimant can show that at least one of the factors listed in s 9 existed and was related to relevant service in the terms required by s 10. Where a factor that is referred to another SOP is invoked, enforcement of that factor’s requirements occurs by applying the other SOP per s 11. The instrument therefore delegates the "enforcement" of its criteria to the statutory processes under the VEA and MRCA.

The instrument records that the RMA’s standards are based on "sound medical‑scientific evidence" and a balance of probabilities approach (s 8). That statement both explains the evidentiary basis of the factors and sets the standard applied by decision-makers. The instrument contains granular temporal and diagnostic thresholds (for example, drugs within 72 hours, injuries within seven days, and dyslipidaemia numeric thresholds in Schedule 1), and those thresholds will be used administratively as the standard to accept or reject causal claims.

There is no administrative enforcement mechanism contained in the Statement for non-compliance by third parties such as clinicians. The instrument does not require reporting by clinicians or impose regulatory obligations on providers. Rather, it requires claimants and decision-makers to adduce and evaluate evidence against the listed factors. Any consequences for failure to establish a listed factor will therefore be reflected in an administrative denial of entitlement under the VEA or MRCA and subsequent merits or judicial review avenues available under those primary statutes and general administrative law, but those review mechanisms are not detailed in this instrument.

The instrument is expressly made under subsection 196B(3) of the Veterans' Entitlements Act 1986 (s 3), and it applies to claims falling to be determined under section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 (s 5). It therefore sits subordinate to those Acts and functions within their statutory claim processes. The RMA’s Statements of Principles are instruments designed to be applied within the adjudicative scheme of the VEA and MRCA; this Statement is not a freestanding entitlement provision.

Section 11 provides a specific mechanism for cross‑instrument interaction: when a factor in s 9 refers to an injury or disease that itself has been the subject of another Statement of Principles, "the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time." This creates a hierarchical and lateral interaction between SOPs. Practically, that means decision-makers and claim preparers must consult the current text of any other SOP referenced (for example, SOPs covering antiphospholipid antibody syndrome, giant cell arteritis, or other diseases listed in Schedule 1 notes) and apply those SOPs’ criteria when those conditions are relied upon as connecting factors.

The instrument refers to the ICD‑10‑AM code H34 (s 7(3)-(4)) but makes clear that the statutory meaning of retinal vascular occlusion for this SOP is the instrument’s own definition in s 7(2). That is, the presence of ICD code H34 is informative but subordinate to the instrument’s definitional text. The instrument therefore interacts with diagnostic coding systems by acknowledging them while preserving the instrument’s textual definition as authoritative for statutory purposes.

Amendments and the compilation notes show legal‑technical interactions with the Legislative Instruments Act 2003 via the compilation and amendment history (endnotes). The endnotes record amending Determination No. 94 of 2022, which altered the definition of "one pack‑year" in the Schedule (see endnotes 3 and 4). Users must therefore be attentive to the current instrument text and to any other SOPs or legislative instruments that have been amended subsequently.

The instrument’s application requires evidence that factors were "related to relevant service" (s 10(1)). What counts as relevant service is defined in the Schedule and links the SOP to categories under the VEA and MRCA. The instrument does not displace or alter the primary Acts’ substantive entitlements, but it prescribes how medical causation will be evaluated by administrative decision-makers operating under those Acts.

Finally, the instrument does not specify procedural review or appeal routes; those continue to be provided by the VEA, MRCA and general administrative law. Any conflict between this SOP and other SOPs will be resolved by applying the instrument text and s 11, and by reference to the primary statutes under which claim decisions are made.

The compilation contains its amendment history in the endnotes. The Statement was made and registered as Determination No. 51 of 2020 on 29 June 2020 and commenced on 27 July 2020 (endnote 3). A subsequent amending Determination, Veterans' Entitlements (Statements of Principles,definition of "one pack-year") Amendment Determination 2022 (No. 94 of 2022), was registered 26 August 2022 and commenced 19 September 2022 (endnote 3). Endnote 4 records specific provisions affected by the 2022 Determination: the Schedule 1 Dictionary definition of "one pack-year" was revised (endnote 4 notes "Schedule 1 - Dictionary - one pack-year... rs No. 94 of 2022"), and related notes in subsections 9(1) and 9(21) were also revised (endnote 4 entries state "Subsection 9(1) note..... rs No. 94 of 2022" and "Subsection 9(21) note... rs No. 94 of 2022").

The compilation’s front matter states that the text is shown "as amended and in force on 19 September 2022" and includes amendments up to the 2022 Determination (Compilation No. 1, compilation date 19 September 2022). The endnotes explain that uncommenced amendments would not be shown and that modifications effected by other laws may not appear in the compilation text except as indicated in the endnotes. The endnotes also include an abbreviation key and standard explanatory material about the compilation.

No earlier legislative histories or repeals are recorded within the instrument itself beyond the amendment references in the endnotes. The instrument’s legal authority remains subsection 196B(3) of the VEA (s 3). Users should note that the Schedule contains substantive definitional changes (for example, the "one pack-year" definition) and that such definitional revisions adjust evidentiary thresholds: the Schedule’s pack‑year definition includes both cigarettes per day calculation and a weight-based equivalence for alternative tobacco products (Schedule 1, one pack-year), which may materially affect how smoking exposure is quantified in claims.

Because the compilation notes that the Schedule and parts of s 9 were revised by Determination No. 94 of 2022, practitioners should check for any further amending determinations after 19 September 2022 when preparing or litigating claims, as the instrument explicitly warns that uncommenced amendments are not shown and that the Legislation Register contains current texts and future amendments (front matter "About this compilation").

The instrument itself contains no statutory references to litigation or judicial decisions, and no cases are named in the text. The compilation’s endnotes (Endnote 3 and 4) record only the registration and amendment history of the Statement and the subsequent Determination that amended the pack‑year definition; they do not record any judicial proceedings. Therefore, within the four corners of this instrument there is no litigation history documented.

Practically, absence of litigation references in the Statement does not preclude litigation in external forums concerning decisions that apply this SOP. The instrument operates as an administrative evidentiary framework for decisions under the VEA and MRCA; merits review and judicial review pathways available under those Acts and general administrative law could be used to challenge decisions that apply or misapply this Statement. However, the Statement text does not itself specify appeal routes, nor does it summarise any appellate or judicial treatment of RMA Statements of Principles.

In preparing claims or challenges that rely on this SOP, practitioners should therefore be aware that the Statement is an administrative instrument designed to inform decision-making under the VEA and MRCA. Any argument about its correct interpretation, or about whether a decision applied its factors accurately, would need to be located in case law external to the instrument. The instrument’s endnotes list only two legislative instruments (the 2020 Determination and the 2022 Determination amending "one pack-year"); they do not list any case law or tribunal decisions.

Given this instrument’s function, litigated disputes are likely to turn on evidentiary matters (e.g., whether a listed factor existed in the required temporal relation to onset or worsening, and whether that factor was related to relevant service per s 10(1)) and on statutory interpretation (e.g., whether a particular disease referenced is governed by another SOP per s 11). But the instrument itself provides no record of prior litigation outcomes nor of any judicial interpretation of its provisions. Practitioners should therefore review administrative tribunal and courts’ decisions involving RMA SOPs generally, outside this instrument, to gauge potential litigation approaches; those materials are not reproduced or summarised in this Statement.

Several practical traps arise from the instrument’s structure and the Schedule’s operational definitions. These can materially affect claim prospects if overlooked.

1. Distinct onset and worsening regimes. The instrument has separate but similar lists of factors for clinical onset (s 9(1)-(20)) and for clinical worsening (s 9(21)-(41)). The legal effect differs: s 10(2) makes clear that the worsening factors (9(21)-9(41)) apply only to material contribution or aggravation where the retinal vascular occlusion was suffered or contracted before or during, but did not arise out of, the person’s relevant service. That is a precise legal constraint. Practitioners must not treat onset and worsening factors as interchangeable; the timing of the original injury relative to service is decisive.

2. Temporal windows are strict. Several factors require precise timing: specified drugs within 72 hours before onset/worsening (s 9(17), 9(37)); direct external pressure to the eyeball for a continuous period of at least ten minutes within 24 hours before onset/worsening (s 9(15), 9(35)); blunt or penetrating injury, or surgery/therapeutic procedure, within seven days (s 9(16), 9(36)); combined oral contraceptive pill use for at least 21 continuous days within one year before onset/worsening (s 9(18), 9(38)). Failure to document these temporal windows precisely may preclude establishing the factor.

3. Smoking calculation specifics. The Schedule’s definition of one pack‑year and the requirement in s 9(1) and s 9(21) for at least 20 pack‑years require careful calculation. The Schedule gives both an example formula and a weight‑based conversion for non-cigarette tobacco (7,300 grams = one pack‑year equivalence). The 2022 Determination amended the one pack‑year definition; practitioners must use the current text (see endnotes 3-4).

4. Objective laboratory thresholds and clinical criteria. Dyslipidaemia is not a vague concept in this instrument; Schedule 1 sets numerical thresholds for total cholesterol, LDL, HDL and triglycerides, or evidence of regular lipid‑lowering therapy. Chronic renal failure is tied to GFR <15 mL/min/1.73 m2 for three months, renal replacement therapy, or chronic dialysis. Ocular hypertension is >21 mm Hg without optic atrophy or visual field loss. Failure to provide objective, contemporaneous clinical measurements may result in an adverse finding.

5. Exclusions and definitions. Retinal vascular occlusion excludes ischaemic optic neuropathy and ophthalmic artery occlusion (s 7(2)(b)); coding with ICD H34 alone is insufficient if the clinical presentation better fits an exclusion. The instrument also specifies that retinal vascular occlusion "means obstruction to blood flow in either the retinal artery or its branches or the retinal vein or its tributaries, leading to visual impairment" (s 7(2)(a)). Practitioners must align clinical diagnoses to that definition.

6. Cross‑references to other SOPs. When a factor refers to an injury or disease that itself has an SOP, s 11 requires the other SOP be applied "as in force from time to time." Failing to identify and apply the relevant SOP could result in missing alternative criteria or thresholds that apply to the factor (e.g., antiphospholipid syndrome, giant cell arteritis).

7. "Inability to obtain appropriate clinical management." Section 9(41) lists inability to obtain appropriate clinical management for retinal vascular occlusion as a factor. That is a non‑medical but evidentiary pathway: the claimant must document attempts to obtain care and the obstacles faced. The instrument does not state what evidence suffices; the administrative decision-maker will assess the proof on the balance of probabilities.

8. Arterial versus venous differences. Some factors apply only to retinal venous occlusion (s 9(19)(a)-(c)) and some only to retinal arterial occlusion (s 9(20) and s 9(40)). For example, open‑angle glaucoma, chronic renal failure, and severe dehydration are venous‑specific. Cardiac sources of embolus, carotid artery disease, and procedures on the heart/carotid are arterial‑specific. Misclassifying the occlusion type or failing to tie the specific factor to the occlusion subtype risks failing the causal test.

9. Death linkage uses terminal event concept. Death from retinal vascular occlusion is included only where death arises from a terminal event or condition contributed to by the retinal vascular occlusion (s 7(5)), and "terminal event" is defined narrowly in the Schedule (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). Proof of causal contribution to the terminal event will therefore be required.

10. The RMA statement is probabilistic. Section 8 makes clear the RMA’s approach is that, on the sound medical‑scientific evidence available, it is "more probable than not" that retinal vascular occlusion can be related to relevant service. This evidentiary posture means that claimants must aim to demonstrate, on balance, that a listed factor existed and related to service; the instrument does not create presumptions beyond the listed factors.

Being attentive to these particulars , definitions, numeric thresholds, timing windows, cross‑references, and the onset/worsening distinction , is essential. A checklist approach that maps available clinical records to the exact statutory wording will be necessary to avoid evidentiary failings.

For practitioners preparing claims or advising claimants, compliance entails assembling evidence that maps directly onto the instrument’s requirements. The following practical checklist aligns documentary tasks with specific provisions.

1. Establish diagnosis and subtype. Obtain ophthalmology records that document a diagnosis consistent with the instrument’s definition of retinal vascular occlusion (s 7(2)), and confirm whether the occlusion is arterial or venous. Note that ICD‑10‑AM H34 may be present (s 7(3)-(4)), but the clinical description must match s 7(2) and exclude ischaemic optic neuropathy and ophthalmic artery occlusion (s 7(2)(b)).

2. Map factors to the correct list. Decide whether the claim is for initial clinical onset (use s 9(1)-(20)) or for clinical worsening of a pre‑existing condition (use s 9(21)-(41)). Apply s 10(2): worsening factors apply only where the condition was suffered or contracted before or during, but not arising out of, relevant service.

3. Document timing precisely. For any factor with temporal requirements, provide contemporaneous records with clear dates:

   • Specified drugs within 72 hours: prescription, hospital chart, or toxicology record (s 9(17), 9(37) and Schedule specified list of drugs).
   • Direct external pressure to the eyeball: operative notes, anaesthesia record, positioning documentation specifying at least ten continuous minutes within 24 hours (s 9(15), 9(35)).
   • Blunt/penetrating injury, surgery or therapeutic procedures: operative reports, emergency department notes, or procedure logs within seven days (s 9(16), 9(36)).
   • Cardiac/carotid/intravascular procedures within seven days for arterial occlusion (s 9(20)(d), s 9(40)(d)).
   • Combined oral contraceptive use: prescription records showing at least 21 continuous days in the 12 months before onset/worsening (s 9(18), 9(38)).
   • Smoking history: provide a smoking history that supports at least 20 pack‑years and evidence of cessation date if relevant (s 9(1), s 9(21) and Schedule definition of one pack‑year).

4. Provide objective clinical measurements. For factors that depend on thresholds, include the tests and dates that meet the Schedule definitions:

   • Dyslipidaemia: lipid panels showing values meeting Schedule 1 thresholds or documentation of regular lipid‑lowering therapy.
   • Chronic renal failure: serial GFR/eGFR reports demonstrating <15 mL/min/1.73 m2 for at least three months, or documentation of renal replacement therapy or chronic dialysis (Schedule 1).
   • Ocular hypertension: intraocular pressure readings >21 mm Hg without optic atrophy or field loss (Schedule 1).
   • Severe dehydration: clinical records documenting oliguria, orthostatic hypotension, or other signs in Schedule 1.

5. Address cross‑referenced conditions. If a factor refers to a disease with its own SOP (e.g., a specified arteritis or hypercoagulable disorder that has a separate RMA SOP), obtain the relevant specialist records and ensure the factor is established as required by that SOP (s 11). Identify and cite the current SOP text when filing supporting submissions.

6. Evidence of relation to relevant service. Under s 10(1), link the existence of the factor to the person’s relevant service. For example, if exposure, positioning, or a procedure occurred in service, obtain service medical records, deployment and duty records, operation logs, and witness statements. Use the Schedule definition of relevant service to identify which service types are within scope.

7. For "inability to obtain appropriate clinical management." If relying on s 9(41), document attempts to access care (referral letters, hospital waitlists, dates of contact), and contemporary clinical notes showing how lack of care contributed to onset or worsening.

8. For death claims, tie retinal vascular occlusion to a terminal event. If seeking entitlement for death, include medical records and death certificate information that establish the retinal vascular occlusion contributed to a listed terminal event in the Schedule (s 7(5) and Schedule terminal event definition).

9. Present chronological synthesis. Provide a succinct chronological narrative aligning clinical events, exposures, and service events to the statutory temporal windows and to the causal pathway. Use clear headings that map evidence to specific subsections (e.g., "s 9(16) , Blunt trauma within 7 days: ED note 10/06/20...").

10. Verify current instrument text and amendments. The Schedule’s definitions, especially the "one pack‑year" change made by Determination No. 94 of 2022, can be outcome determinative. Confirm you are using the version "in force" (the compilation notes advise checking the Legislation Register for uncommenced or later amendments).

11. Anticipate the standard of proof. Section 8 frames the RMA’s view as requiring the condition to be "more probable than not" related to service. Structure evidence to meet that balance of probabilities: contemporaneous clinical records, objective test results, and clear linking evidence to service events.

12. Cross‑check exclusions and differential diagnoses. Because retinal vascular occlusion is narrowly defined (s 7(2) and exclusions), ensure alternative diagnoses are addressed and excluded in records or expert opinion, particularly ophthalmological assessments that differentiate vascular occlusion from optic neuropathy or ophthalmic artery occlusion.

Following this mapping will produce evidence that directly corresponds to the instrument’s requirements. The instrument’s utility is in its specificity; compliance therefore depends on producing records keyed to the instrument’s words, temporal limits, and numerical thresholds.