Statement of Principles concerning retrocalcaneal heel bursitis (Reasonable Hypothesis) (No. 88 of 2024)

The instrument is short and conceptually focused. Its main concepts are the medical scope, the reasonable hypothesis test as a fact-finding device, specified exposure or co-morbidity factors, the temporal connection to service, and cross-application to other Statements of Principles.

Medical scope. The instrument defines the condition in clause 7(2): retrocalcaneal heel bursitis is inflammation of the deep Achilles bursa between the distal Achilles tendon and the calcaneus bone, excluding posterior adventitial heel bursitis. Clause 7(3) extends the condition to include death from a terminal event or condition contributed to by the condition. The Schedule supplies a definition of terminal event, listing examples such as pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function.

Reasonable hypothesis framework. The Statement is made under subsection 196B(2) of the VEA (clause 3). That statutory mechanism is used by the Repatriation Medical Authority to set out the facts and factors that, if established and related to relevant service, are sufficient to raise a "reasonable hypothesis" that the condition or death is connected to service (clause 8 and clause 9). The instrument does not itself detail the legal test beyond saying that "at least one of the following factors must as a minimum exist" to raise the reasonable hypothesis (clause 9).

Enumerated factors and thresholds. Clause 9 contains the operative, listed factors. They include: sustained running or jogging averaging at least 30 kilometres per week for the 4 weeks before clinical onset or clinical worsening; undertaking weight-bearing exercise involving repeated ankle activity at a minimum intensity of 5 METs for at least 4 hours per week for at least 4 weeks before onset or worsening (with examples provided and a brief note on what METs measure); having specified systemic arthritic diseases at time of onset or worsening (a list of nine conditions including ankylosing spondylitis, gout, rheumatoid arthritis and others); having chronic renal failure in the 10 years before onset or worsening as indicated by specified GFR or dialysis criteria; having a bacterial infection of the affected retrocalcaneal bursa at time of onset or worsening; wearing footwear that causes excessive pressure on the posterior heel at the time of onset or worsening; and inability to obtain appropriate clinical management before clinical worsening (clause 9(1)-(7) and accompanying notes).

Temporal and service-relationship rules. Clause 10 requires that the existence of any factor in clause 9 must be related to the person’s relevant service. Clause 10(2) limits the clinical worsening aspects of clause 9 to material contribution to, or aggravation of, the condition where the bursitis was suffered or contracted before or during, but did not arise out of, the person’s relevant service. The Schedule defines "relevant service" by listing the forms of service under the VEA and MRCA (operational, peacekeeping, hazardous, British nuclear test defence service, warlike and non-warlike service).

Cross-application to other Statements of Principles. Clause 11 instructs that if a factor in clause 9 refers to an injury or disease that is the subject of another Statement of Principles made under subsection 196B(2) of the VEA, then the factors in that other Statement apply according to its terms in force from time to time. That makes this instrument interact dynamically with the corpus of other Statements of Principles.

Institutional provenance. The instrument is made by the Repatriation Medical Authority and is expressly under subsection 196B(2) of the VEA (clause 3). The Schedule confirms that MRCA and VEA are defined terms and repeats the list of "relevant service" categories used to attach service links.

Primary persons affected. The instrument applies to claimants who seek to establish that retrocalcaneal heel bursitis or death from retrocalcaneal heel bursitis is connected to their relevant service for the purposes of VEA and MRCA claims (clause 5). The Schedule defines "relevant service" to include a range of service types under the VEA and MRCA, namely operational service, peacekeeping service, hazardous service, British nuclear test defence service, warlike service and non-warlike service. Therefore serving or former members whose entitlements hinge on those categories are the primary cohort.

Decision-makers and administrators. The Repatriation Medical Authority is the issuer of the statement (clause 3). The instrument supplies the medical-scientific basis and factor list that decision-makers administering the VEA and MRCA will use when assessing whether a reasonable hypothesis connects the condition or death to relevant service. The instrument itself does not set the entitlements paid; it sets the evidentiary and medical thresholds to be used by the statutory decision-makers under the VEA and MRCA. Those decision-makers are affected because they must apply the criteria in clauses 7-11 when determining whether the reasonable hypothesis threshold is met.

Medical practitioners and expert witnesses. The Statement identifies particular clinical findings and exposures that are material: running distances and durations, METs and hours of weight-bearing exercise, diagnoses of listed systemic arthritic diseases, objective renal function criteria, bacterial infection of the bursa, footwear pressure, and access to clinical management. Treating clinicians, independent medical examiners and forensic clinicians will be called upon to provide records or opinions directed at those criteria.

Third parties and documentation sources. Unit records, exercise logs, training programs, equipment issue records, footwear provisioning, pathology results (for infection and for renal function), dialysis records, imaging and clinical notes, and referral histories will be relevant sources of evidence. The Statement therefore affects record-keeping practices and evidentiary collection by units, medical services and claimants.

Cross-affected claim subsets. Where clause 9 refers to another injury or disease that has its own Statement of Principles, those other Statements will apply as in force (clause 11). That creates overlap for claimants with co-morbid or related conditions. The repeal of the 2015 Achilles Statement (clause 4) also changes the legal instrument landscape and therefore affects claimants whose earlier claims were assessed under that repealed Statement.

Indirectly affected actors. While not named in the instrument, insurers, rehabilitation providers and legal advisers who assist claimants will be affected by the change in the statement of factors and by the evidentiary approaches claimants must take. The instrument alters what is material in a claim for the named condition and therefore alters the advice these professionals give.

Groups not covered. The instrument explicitly excludes posterior adventitial heel bursitis from the definition of retrocalcaneal heel bursitis (clause 7(2)(b)). Persons whose condition is exclusively posterior adventitial heel bursitis are therefore outside the scope of this Statement and must rely on any other applicable Statements or legal pathways, if any.

Temporal scope. The Statement applies to claims to which section 120A of the VEA or section 338 of the MRCA apply (clause 5), and it commences on 19 November 2024 (clause 2). Any claims made after commencement will be assessed against this instrument; the instrument repeals the 2015 Statement (clause 4), so assessments after commencement will be under this Statement rather than the repealed one.

Statutory duty of the Authority. The Repatriation Medical Authority has exercised its function under subsection 196B(2) of the VEA by issuing this Statement (clause 3). The document does not impose regulatory duties on third parties; rather it prescribes the medical factors that decision-makers under the VEA and MRCA will use to determine whether a reasonable hypothesis exists.

Duty to relate factors to service. For a factor listed in clause 9 to be operative in raising the reasonable hypothesis, the instrument requires that the existence of that factor "must be related to the relevant service rendered by the person" (clause 10(1)). That is a threshold duty placed on whoever is establishing the connection in a claim. The instrument does not define the evidentiary standard for proving that relationship; it simply requires the relationship to exist.

Scope of clinical worsening. Clause 10(2) places a duty on decision-makers to treat clinical worsening aspects of the factors in clause 9 only where the person’s retrocalcaneal heel bursitis was suffered or contracted before or during, but did not arise out of, relevant service. Thus, clinical worsening can establish material contribution or aggravation, but only in the limited factual configuration specified.

Application to other Statements of Principles. Clause 11 requires that if a factor in clause 9 refers to a disease or injury that is the subject of another Statement of Principles under subsection 196B(2) of the VEA, then the factors in that other Statement apply according to its terms as in force from time to time. This creates a duty to consult and apply other Statements where clause 9 invokes them.

Rights implied by the Statement. The instrument confers no direct monetary right. Its legal effect is to provide an authoritative list of factors that, if established and linked to relevant service, are sufficient to raise the reasonable hypothesis and thereby allow whatever procedural and benefit rights flow from establishing that threshold under the VEA and MRCA. The Schedule’s definition of terminal event expands the concept of "death from the condition" to include listed terminal events when bursitis contributed, which affects how death claims can be framed.

Evidence and proof obligations. The Statement makes certain medical facts and exposures material. Practically, claimants or their representatives will have to present evidence that some element in clause 9 applied at the relevant time and was related to service. The Statement makes clear which medical facts are determinative for the reasonable hypothesis, for example the numeric running threshold (30 kilometres per week, for the 4 weeks before clinical onset or worsening), the METs, the GFR threshold and dialysis criteria for chronic renal failure, and the presence of a bacterial infection of the retrocalcaneal bursa at the time of onset or worsening (clause 9). That implies an evidentiary burden to produce records, clinical notes, laboratory values, or contemporaneous documentation.

No penalties or criminal sanctions in the Statement. The instrument does not create offences, fines or administrative penalties. Its effect is confined to evidentiary guidance for the reasonable hypothesis inquiry and the application of the VEA and MRCA claims processes.

Temporal commencement duty. The Statement commences on 19 November 2024 (clause 2). Decision-makers have a duty to apply the Statement to claims covered by the specified sections after that date, and to treat the repealed 2015 Statement as no longer in force for the purposes of the VEA (clause 4).

The instrument does not create criminal offences, civil penalties, licensing requirements or express enforcement powers within its text. It is a Statement of Principles made under subsection 196B(2) of the VEA and its legal operation is evidentiary and administrative, not punitive (clause 3 and clause 8). There are therefore no penalty provisions within the instrument itself to enforce compliance by claimants, clinicians or other parties.

Enforcement in practice will occur through the VEA and MRCA decision-making processes. The instrument applies to claims to which section 120A of the VEA or section 338 of the MRCA apply (clause 5). Administrative decision-makers applying those provisions will use the Statement as the medical standard for determining whether a reasonable hypothesis connects retrocalcaneal heel bursitis or death from it to the person’s relevant service. Any adverse administrative decision under the VEA or MRCA, or a refusal to accept a claim on the basis that the Statement’s factors are not met or not related to service, would be enforced through the standard appeal, review or merits processes that exist under the parent statutes. The Statement itself does not set out those appeal processes, and it does not alter statutory appeal rights in the VEA or MRCA.

Sanctions for false evidence or misleading conduct are not provided by this Statement. The instrument does not supply disciplinary mechanisms for clinicians or claimants who provide false information. Any such issues would be dealt with under the general law or under the statutory schemes that govern VEA or MRCA claims, not by the Statement itself.

Operational enforcement. Decision-makers must operationalise the Statement by assessing claim evidence against the listed factors in clause 9 and the requirement that any factor be related to relevant service (clause 10(1)). The Statement instructs how to treat factors that point to diseases covered by other Statements: those other Statements apply in accordance with their terms (clause 11). The practical enforcement of the Statement is therefore via administrative assessment protocols and case management by the relevant departments and tribunals.

No external compliance instruments. The Statement does not impose reporting obligations, audit powers or compliance checks on employers, units, medical practitioners or claimants. It identifies specific clinical and exposure facts that will be taken as raising a reasonable hypothesis if established, but it does not mandate how those facts must be recorded or produced beyond the requirements of the VEA and MRCA decision-making processes.

Relevance of dates. The instrument’s commencement and repeal provisions are the only temporal enforcement hooks within the text. The Statement commences on 19 November 2024 (clause 2) and repeals the 2015 Statement (clause 4). The effect of those dates on existing claims will be determined by administrative processes under the VEA and MRCA, not by this Statement directly.

Primary statutory anchors. The Statement is made under subsection 196B(2) of the VEA (clause 3). It explicitly applies to claims to which section 120A of the VEA or section 338 of the MRCA apply (clause 5). The instrument therefore functions as an evidentiary annex to those statutory schemes and should be read in conjunction with the parent Acts. The Statement does not alter the substantive entitlements or appeal mechanisms contained in the VEA or MRCA. It constitutes an authoritative medical determination to be used when assessing the reasonable hypothesis threshold.

Interaction with other Statements of Principles. Clause 11 creates direct cross‑instrument interaction. If a factor in clause 9 refers to an injury or disease that is itself the subject of another Statement of Principles made under subsection 196B(2) of the VEA, then the factors in that other Statement apply as in force from time to time. That means the Statement delegates part of its evidentiary content to the corpus of other Statements where overlap exists. Decision-makers will therefore need to consult both this Statement and any referenced Statements relevant to the factors invoked.

Repeal of prior Statement. Clause 4 repeals the Statement of Principles concerning Achilles tendinopathy and bursitis (Reasonable Hypothesis) (No. 96 of 2015). That repeal removes an earlier instrument that may have covered overlapping conditions. The practical effect is that for the condition specified in this Statement, decision-makers should apply the new instrument from its commencement date. How the repeal affects transitional or in‑progress claims will depend on the administration of the parent Acts; the instrument itself does not set transitional rules.

Definitions and their statutory import. The instrument uses defined terms in Schedule 1, including MRCA, VEA and relevant service. The Schedule defines "relevant service" by reference to categories under the VEA and MRCA: operational service, peacekeeping, hazardous, British nuclear test defence service, warlike and non-warlike service. That means the instrument’s reach for causation is tethered to those service categories in the parent Acts. For a factor to have the required effect, it must be related to those forms of service per clause 10(1).

Medical criteria and other regulatory regimes. The instrument sets precise medical thresholds (for example, running 30 kilometres per week for 4 weeks, or GFR less than 15 mL/min/1.73 m2 for at least 3 months within the 10 years before clinical onset or worsening). These are used within the VEA/MRCA compensation regime as determinative medical markers. The Statement does not displace medical standards in other regulatory contexts such as workers compensation, private health insurance, or professional negligence law. It applies only for the purposes of raising a reasonable hypothesis under the VEA and MRCA.

No conflict or primacy clause. The instrument does not contain an express primacy clause stating how it operates if its definitions conflict with other legislation. Its practical primacy is limited to the context of subsection 196B(2) VEA and the decision-making processes under the VEA and MRCA which reference these Statements. Any legal conflicts with other statutes would be resolved under general principles of statutory interpretation and through the decision and review processes established by the parent Acts.

Evidence-sharing and privacy. The Statement does not create obligations or permissions for disclosure of medical or service records. Interactions with privacy law, Freedom of Information law, or administrative disclosure rules will be governed by the parent Acts and general law, not by this Statement.

This instrument is self-contained regarding amendment history. It is dated 18 October 2024 and commences on 19 November 2024 (clause 1 and clause 2). Clause 4 expressly repeals the earlier Statement of Principles concerning Achilles tendinopathy and bursitis (Reasonable Hypothesis) (No. 96 of 2015) (Federal Register of Legislation No. F2015L01336). No other amendments, prior versions, or historical iterations are contained within the text.

There are no transitional provisions or savings clauses in the instrument that preserve the operation of the 2015 Statement for ongoing claims. The repeal is categorical in clause 4. The instrument does not state whether the 2015 Statement will continue to be applied to claims lodged before commencement; that will need to be resolved by reference to administrative practice under the VEA and MRCA or by locating any separate transitional instrument or departmental guidance, none of which appear in the text supplied.

The only procedural metadata supplied is the authority clause indicating the statutory basis for the instrument under subsection 196B(2) of the VEA (clause 3) and the Schedule’s inclusion of defined terms. The Schedule confirms that MRCA and VEA are the parent Acts under which relevant service categories are defined. The instrument does not include a record of prior amendments to this instrument because it is a new statement taking the place of the repealed 2015 Statement.

To track future changes, users should monitor instruments made under subsection 196B(2) of the VEA and any updates published by the Repatriation Medical Authority or by the Federal Register of Legislation. The instrument’s clause 11 anticipates other Statements will be "in force from time to time", which implies that the corpus of Statements is dynamic and that amendments to other Statements will have practical effect for factors that cross‑refer.

The instrument text contains no litigation history, judicial citations, or references to cases. It was made by the Repatriation Medical Authority under subsection 196B(2) of the VEA (clause 3) and contains only the Statement language, definitions and factor lists. The Statement does not identify any precedential decisions, and it does not cite any case law or tribunal decisions.

Because the instrument is an administrative medical standard used in VEA and MRCA claims, disputes about its application, interpretation or the sufficiency of evidence are likely to be litigated or reviewed within the statutory review pathways provided by the VEA and MRCA. However, the instrument itself contains no record of such litigation, no references to past judicial interpretations of similar statements, and no indication of contested points that were judicially resolved prior to its issuance.

Users requiring information about litigation or case law that interprets Statements of Principles, reasonable hypothesis standards, or the interaction between medical evidence and VEA/MRCA decision-making will need to consult tribunal and court records external to this instrument. The instrument identifies the statutory authority for its issuance and the factors that must exist for a reasonable hypothesis to be raised, but it does not describe how tribunals or courts have applied these or related Statements in contested cases.

Finally, the instrument’s repeal of the prior 2015 Statement is noted; any litigation that considered the 2015 Statement would concern that repealed instrument. The text before you does not summarise any such litigation.

Narrow medical scope. The instrument defines retrocalcaneal heel bursitis narrowly as inflammation of the deep Achilles bursa between the distal Achilles tendon and the calcaneus bone, and explicitly excludes posterior adventitial heel bursitis (clause 7(2)). If a claimant’s heel pathology is described as posterior adventitial heel bursitis, this Statement does not apply. That definitional exclusion is decisive for scope.

At least one specified factor required. The Statement requires that "at least one of the following factors must as a minimum exist" to raise a reasonable hypothesis (clause 9). The factors are narrowly specified and numerically precise in multiple instances. Failure to establish any of the listed factors, or failure to connect an established factor to relevant service (clause 10(1)), means the Statement does not supply the reasonable hypothesis. In contrast to some broader causation frameworks, this instrument is not open‑ended; it is prescriptive.

Temporal tightness of exercise thresholds. The running threshold is an average of at least 30 kilometres per week for the 4 weeks before clinical onset or clinical worsening (clause 9(1)). The weight-bearing exercise pathway requires a minimum intensity of 5 METs, at least 4 hours per week, for at least the 4 weeks before clinical onset or clinical worsening (clause 9(2)). These are short-term, recent-exposure thresholds tied to the immediate pre-onset period. Evidence must show both the intensity and the duration in the specified 4‑week window.

METs conversion and evidence challenge. Clause 9(2) uses METs as the intensity metric and provides examples in Note 1, but METs are technical and require conversion from activity descriptions. Establishing a 5 MET intensity level and the requisite hours per week will often require expert clinical opinion or validated activity records. The Note provides examples of activities considered to reach the 5 MET threshold, but translating a claimant’s described activities into METs is a non-trivial evidentiary task.

Clinical worsening restricted to pre-existing conditions. Clause 10(2) limits clinical worsening pathways to cases where bursitis was suffered or contracted before or during relevant service but did not arise out of relevant service. That means aggravation of a pre‑existing condition is recognised, but the claimant must show the condition pre-existed service or was contracted during it and was subsequently worsened in a way that materially contributed to the present state. The Statement does not permit the clinical worsening criteria to establish causation where bursitis first arose out of service.

Chronic renal failure criteria are strict and time-limited. Clause 9(4) requires chronic renal failure within the 10 years before clinical onset or worsening, and specifies either a GFR less than 15 mL/min/1.73 m2 for at least 3 months or undergoing chronic dialysis. That is a high threshold for renal impairment and is confined to a 10-year lookback. Claimants with lesser renal impairment or with renal failure outside the 10-year window will not meet that factor.

Bursal infection requires local evidence. Clause 9(5) requires having a bacterial infection of the affected retrocalcaneal bursa at the time of clinical onset or clinical worsening. Proving bursal infection typically requires aspiration, culture, imaging and contemporaneous clinical notes. Absent such evidence, establishing this factor will be difficult.

Footwear and subjectivity. Clause 9(6) requires wearing footwear that causes excessive pressure on the posterior heel of the affected foot at the time of clinical onset or clinical worsening. "Excessive pressure" is a qualitative term that will require evidence about the footwear type, fit, any issued footwear in service, or expert footwear assessment. Documentary proof may be limited, and the assessment is fact-sensitive.

Inability to obtain appropriate clinical management is open-ended. Clause 9(7) allows inability to obtain appropriate clinical management before clinical worsening to be a factor. This is potentially subjective and fact-bound. Decision-makers may require contemporaneous records of attempts to obtain care, evidence of access barriers, wait times, or administrative obstacles. The Statement does not define "appropriate clinical management," leaving room for dispute.

Cross-references can import different rules. Clause 11 means that where clause 9 invokes another injury or disease covered by a separate Statement of Principles, the factors and terms of that other Statement will control. That can complicate preparation of claims, because additional Statements may impose their own numeric or diagnostic thresholds and may be updated independently.

Repeal implications. Clause 4 repeals the 2015 Achilles Statement. Some claimants or advisors who previously relied on the 2015 Statement should not assume that prior approaches will map directly onto the new Statement. The instrument does not provide transitional guidance or savings, so timing and administrability of the repeal could create uncertainty for claims in progress.

Death claims require causal contribution. Clause 7(3) extends the definition to death from a terminal event or condition that was contributed to by the person’s retrocalcaneal heel bursitis. The Schedule’s terminal event list indicates examples. For death claims, medical evidence must show that the bursitis materially contributed to the terminal event listed in the Schedule, not merely that the bursitis was present. That is an evidentiary hurdle in fatality cases.

No penalties or evidentiary procedures stated. The Statement provides the substantive factors for the reasonable hypothesis but does not state procedural rules, evidentiary presumptions, or how to weigh competing medical opinions. Those procedural elements will derive from the VEA and MRCA practices and not from the Statement itself.

Collect contemporaneous and objective evidence mapped to clause 9. The Statement identifies specific factual criteria. To meet the running test (clause 9(1)), assemble running logs, training schedules, unit training orders, wearable device records, or witness statements that show an average of at least 30 kilometres per week for the 4 weeks immediately prior to clinical onset or worsening. For the weight-bearing exercise pathway (clause 9(2)), document the type of activity, frequency and duration, and obtain a clinician’s opinion that the described activities meet a minimum intensity of 5 METs for the required hours. Use the Note examples (marching, basketball, football, volleyball, track and field) to contextualise activities but secure clinician corroboration converting activities into METs.

Medical records for systemic disease and renal failure. For factors that depend on diagnosed systemic arthritic diseases (clause 9(3)), obtain specialist letters, rheumatology clinic notes, diagnostic codes and treatment histories that demonstrate the specified diagnoses at the time of clinical onset or worsening. For chronic renal failure (clause 9(4)), secure pathology and nephrology records showing a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a continuous period of at least 3 months within the 10 years before onset, or records showing chronic dialysis. Ensure dates are explicit to meet the 10-year lookback.

Document infection of the bursa. For a bacterial infection of the retrocalcaneal bursa (clause 9(5)), provide bursal aspiration results, microbiology culture reports, imaging reports indicating bursitis with infection, surgical or procedural records, and contemporaneous clinical notes describing signs of local infection at the time of onset or worsening.

Footwear evidence. For the footwear factor (clause 9(6)), collect issue records for service footwear, procurement records, photographs of the footwear as worn, medical notes that document pressure points or external markers, ergonomic or podiatric assessments, and any complaints lodged at the time of use. Statements from unit fitters or medical personnel who examined the footwear or observed pressure injuries will be helpful.

Establishing inability to obtain appropriate clinical management. For the inability to obtain appropriate clinical management pathway (clause 9(7)), compile contemporaneous records showing attempts to obtain care: referral letters, appointment lists, waiting period confirmations, correspondence with medical services or administrators, and notes explaining why care was not obtained. A clinician’s statement that a delay or absence of appropriate treatment contributed to clinical worsening will be material.

Relate factors to relevant service. The Statement requires that any established factor be related to relevant service (clause 10(1)). Prepare evidence tying the exposure or condition to the listed forms of service in the Schedule. This may include service records, unit tasking orders, deployment rosters, operational diaries, training schedules, photo evidence, or statements from commanding officers that connect the activities or conditions to the person’s relevant service period. For clinical worsening paths, ensure records show the condition pre-existed or was contracted before or during relevant service, as required by clause 10(2).

For death claims, document contribution to terminal event. If the claim is for death from the condition, obtain the death certificate, hospital and emergency records, specialist opinions, and pathology or autopsy reports that link the presence or consequences of retrocalcaneal heel bursitis to the terminal event specified in the Schedule. Clinician opinions must explicitly state how bursitis materially contributed to the proximate or ultimate cause of death.

Use cross-references responsibly. If a factor in clause 9 refers to another disease covered by a separate Statement, identify that Statement and collect evidence required under its terms, because clause 11 imports those other Statement provisions. Ensure that evidence collected meets the potentially different thresholds in the other Statement that clause 9 invokes.

Prepare expert clinical opinions that address the Statement directly. Given the technical thresholds (METs, GFR numeric thresholds, bacterial infection diagnostics), obtain contemporaneous treating clinicians’ notes and, where necessary, independent medical or specialist reports that address the specific clause 9 factors, the temporal link to onset or worsening, and the relation to relevant service. Expert opinions should map facts to the precise wording of the Statement.

Check dates against commencement and repeal. Be conscious of the instrument’s commencement on 19 November 2024 (clause 2) and the repeal of the 2015 Statement (clause 4). For claims spanning the repeal date, clarify with administrators which instrument applies or whether transitional arrangements apply. The Statement itself does not provide transitional rules.

Record-keeping and witness statements. Maintain contemporaneous statements from supervisors, colleagues, teammates, unit medical staff, or trainers who can corroborate training loads, footwear issues, or attempts to access care. Photographic or electronic evidence of footwear and training environments can be persuasive.

Anticipate challenges on qualitative factors. For subjective or qualitative elements (for example, "excessive pressure" from footwear or "inability to obtain appropriate clinical management"), supplement narrative statements with objective indicators such as skin integrity documentation, infection markers, appointment waitlists, and official denial or delay letters.

Reference the instrument in submissions. Lawyers, advocates and claimants should explicitly cite clauses 7 to 11 and Schedule 1 in written submissions and medical reports to ensure decision-makers assess the evidence against the precise Statement criteria. When a factor invokes another Statement of Principles, cite that other Statement and its relevant clauses in submissions as required by clause 11.

Prepare for cross-instrument complexity. If conditions overlap with other Statements, map out which instruments apply and whether their factors are cumulative or alternative. Because clause 11 binds decision-makers to apply other Statements "as in force from time to time", monitor any updates to those Statements.

In sum, compile precise, dated, objective records and expert opinions that align with the narrow, listed factors in clause 9, show the required temporal windows, and demonstrate the relationship to the service types listed in the Schedule.