Statement of Principles concerning sarcoidosis (Reasonable Hypothesis) (No. 60 of 2025)

The instrument is short and conceptually focused. Its main legal and medical concepts are the statutory meaning of sarcoidosis, death from sarcoidosis, the minimum factors that raise a reasonable hypothesis linking the condition to relevant service, temporal windows for those factors, and the relationship of those factors to relevant service. Each of those appears explicitly in the text.

Statutory meaning of sarcoidosis. The instrument defines sarcoidosis as "a chronic, multisystem disorder characterised in affected organs by an accumulation of T lymphocytes and mononuclear phagocytes, non-caseating epithelioid granulomas, and derangement of the normal tissue architecture" (Kind of injury, disease or death, s7(2)). The instrument notes that although sarcoidosis attracts ICD‑10‑AM code D86, the statutory meaning is the definition in s7(2) and refers to a specific edition of ICD‑10‑AM if the code is relied upon for classification (s7(3)-(4)). The cross‑reference to ICD‑10‑AM is descriptive and confined to the edition identified; the legal meaning for this instrument is the clause in s7(2).

Death from sarcoidosis. Death is included where a terminal event or condition was contributed to by the person's sarcoidosis (Death from sarcoidosis, s7(4)). "Terminal event" is defined in the Schedule to include examples such as pneumonia, respiratory failure, cardiac arrest, circulatory failure, and cessation of brain function (Schedule - terminal event). Thus the instrument extends to deaths where sarcoidosis materially contributed to a proximate cause of death listed in the Schedule.

Reasonable hypothesis and minimum factors. The instrument uses the statutory phrase "reasonable hypothesis" and sets out that at least one of the listed factors must exist before it can be said a reasonable hypothesis has been raised linking sarcoidosis or death from sarcoidosis with relevant service (Factors that must exist, s9). The list is finite and specific. It includes:

• taking BRAF/MEK inhibitors, immune checkpoint inhibitors, or interferons within five years before clinical onset or clinical worsening (s9(1)(a)-(c)); notes give drug examples for each class;
• being treated for HIV infection with antiretroviral drugs within two years before clinical onset or clinical worsening (s9(2));
• receipt of an organ or tissue transplant, other than corneal, from a donor with sarcoidosis within two years before clinical onset (s9(3));
• inability to obtain appropriate clinical management for sarcoidosis before clinical worsening (s9(4)).

Temporal and causal linkage. The instrument requires the existence of any factor referred to in s9 to be "related to the relevant service rendered by the person" (Relationship to service, s10(1)). That links the factual factor to the statutory category of relevant service as defined in the Schedule. The instrument further narrows the operation of the "clinical worsening" aspects of the factors: where clinical worsening is invoked, it applies only to material contribution to, or aggravation of, sarcoidosis where the sarcoidosis was suffered or contracted before or during, but did not arise out of, the person's relevant service (s10(2)). This is a discrete concept that distinguishes aggravation of pre‑existing or service‑concurrent but not service‑caused disease from disease arising out of service.

Interaction with other Statements of Principles. If a factor in s9 refers to an injury or disease that is the subject of another SOP under s196B(2), then the factors in that other SOP apply according to its terms (s11(1)-(2)). That is a direct textual rule for cross‑application of other RMA Statements of Principles.

Basis statement. The instrument records the RMA's view that there is sound medical‑scientific evidence supporting a relationship between sarcoidosis and relevant service (Basis for determining the factors, s8). The phrase predicates the instrument on the RMA's assessment; the instrument itself does not summarise that evidence beyond listing the factors the RMA considers relevant.

Definitions and scope. The Schedule defines MRCA, relevant service (listing the specific categories under VEA and MRCA), sarcoidosis cross‑reference, terminal event, and VEA (Schedule 1 - Dictionary). Relevant service includes operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike and non‑warlike service under the MRCA, thereby mapping the instrument’s application to the statutory service categories (Schedule - relevant service).

These concepts together make the instrument an evidentiary framework for assessing causal linkage between sarcoidosis, or death from it, and a person’s relevant service. The instrument sets precise factual predicates and temporal windows that will be used in determining whether the statutory threshold of a reasonable hypothesis is met, and instructs claim handlers to look to other SOPs where cross‑referenced injuries or diseases are involved.

This Statement of Principles is directed at the decision environment for claims under the VEA and the MRCA. The text expressly states it applies to a claim to which section 120A of the VEA or section 338 of the MRCA applies (Application, s5). Those cross‑references identify the statutory claim pathways to which the SOP will be relevant. The instrument was made by the Repatriation Medical Authority under subsection 196B(2) of the VEA (Authority, s3), which is the statutory power to determine Statements of Principles. The Schedule defines relevant service to include specific categories of service under the VEA and under the MRCA (Schedule - relevant service).

Who will be materially affected in practice:

• Claimants who are current or former members of the forces who assert an entitlement under s120A of the VEA or s338 of the MRCA where sarcoidosis, or death from sarcoidosis, is alleged to be connected to their relevant service (Application, s5; Schedule - relevant service).
• Medical and claims assessors who determine whether a "reasonable hypothesis" has been raised linking sarcoidosis to relevant service will use the factors identified in s9 and the linkage rule in s10.
• Parties who must adduce medical and other evidence about the existence and timing of listed factors, such as medication histories, transplant records, HIV treatment histories, evidence of inability to obtain appropriate clinical management, and clinical onset/worsening dates, will be affected because those items form the factual predicates for the SOP’s application (Factors that must exist, s9).

The instrument does not itself create entitlements, payments, penalties, or a decision to grant benefits. It operates as a determinative piece of medical‑evidentiary guidance that will be applied within the VEA/MRCA claims process. The RMA has made the instrument under its statutory power to set Statements of Principles (Authority, s3); the instrument then becomes a standard for claim assessment in the relevant statutory channels (Application, s5). The Schedule’s definition of relevant service determines which categories of service will trigger the instrument’s application (Schedule - relevant service).

The instrument also affects clinical evidence gathering and record keeping for affected individuals, because claimants or their representatives will need to marshal evidence that shows the presence of at least one of the factors in s9, and that the factor is related to their relevant service per s10(1). It also affects how multi‑morbidity or overlapping disease categories are addressed, because where a s9 factor refers to another Statement of Principles, that other SOP’s factors will apply (s11).

The text does not set out administrative pathways for how decisions will be communicated or how existing claims will be transitioned from the repealed 2016 SOP to this 2025 SOP, beyond the repeal provision (Repeal, s4) and commencement date (Commencement, s2). The instrument itself is therefore an evidentiary tool to be used in the statutory claims processes applied to persons who fall within the defined relevant service categories.

The instrument does not impose criminal sanctions or new statutory duties on private individuals. Instead, it prescribes evidentiary minima and linkage rules to be used when assessing whether a "reasonable hypothesis" exists that sarcoidosis or death from sarcoidosis is connected to relevant service (Factors that must exist, s9; Relationship to service, s10). That shifts practical burdens in the claim context as follows, in terms grounded in the text.

Rights and entitlements available to a claimant. The instrument provides the framework under which a claimant may establish that a reasonable hypothesis exists linking sarcoidosis to their relevant service. If a claimant adduces evidence that at least one of the factors in s9 existed in the relevant temporal window and that the factor is related to their relevant service per s10(1), then the threshold described in the instrument for raising a reasonable hypothesis will be met for the purposes of the claims process (s9; s10(1)). The instrument therefore gives claimants an evidentiary pathway to make out linkage where one of the enumerated factors is present.

Practical duties or evidentiary requirements. The instrument requires, at minimum, proof of one of the s9 factors. For example, evidence that a claimant took a listed medication within five years before clinical onset or clinical worsening is required where that factor is relied upon (s9(1)). Similarly, proof of treatment with antiretroviral drugs within two years before clinical onset or worsening is required where s9(2) is invoked. For s9(3), records showing receipt of an organ or tissue transplant from a donor with sarcoidosis within two years are required. For s9(4), evidence must support the assertion of an inability to obtain appropriate clinical management before clinical worsening. The instrument leaves "appropriate clinical management" undefined in the Schedule, so the evidentiary task will rest on the claimant and assessing authorities to establish what was or was not available (s9(4); Schedule).

Requirement of relationship to relevant service. The instrument requires that any s9 factor relied upon "must be related to the relevant service rendered by the person" (s10(1)). That places a causal or associative link requirement between the listed factor and the person’s service history as defined in the Schedule. The Schedule’s definition of relevant service lists operational, peacekeeping, hazardous, British nuclear test defence under the VEA, and warlike and non‑warlike service under the MRCA, thereby fixing the categories of service to which the relationship requirement applies (Schedule - relevant service).

Narrowing of "clinical worsening" concept. The "clinical worsening" aspects of the factors in s9 apply only where the person’s sarcoidosis was "suffered or contracted before or during (but did not arise out of) the person's relevant service" and the factor materially contributed to, or aggravated, the sarcoidosis (s10(2)). This is a textual limitation that changes the legal effect of an identified factor if the disease is pre‑existing or service‑concurrent but not service‑caused. Practically, claimants seeking to rely on clinical worsening must establish both the pre‑service or during‑service non‑service causation of the condition and the material contribution/aggravation by the listed factor.

Cross-application of other SOPs. Where a s9 factor refers to an injury or disease covered by another Statement of Principles under s196B(2), the factors in that other Statement will apply according to its terms (s11). In practice, that creates a procedural duty to identify cross‑referenced SOPs and to apply their factors in assessing claims.

Administrative and evidentiary duties of decision makers. The instrument was made under s196B(2) (s3) and applies to claims under s120A VEA and s338 MRCA (s5). While the instrument itself does not specify procedural steps for decision makers, its structure imposes an evidentiary duty on assessors to check whether at least one s9 factor exists and whether that factor is related to the claimant’s relevant service as defined in the Schedule. The RMA has recorded an evidentiary basis for its view that the factors are medically relevant (s8), and decision makers will apply the instrument as the medical standard in the claims context.

What the instrument does not do. It does not create a statutory entitlement to compensation or benefits in its own terms. It does not prescribe how decision makers must quantify contribution or aggravation. It does not define "appropriate clinical management" in the Schedule. It does not provide appeal or review mechanisms beyond those existing in the VEA and MRCA frameworks. Those procedural elements remain governed by the underlying statutes and administrative processes to which this instrument applies (Application, s5).

The Statement of Principles instrument contains no penal provisions, monetary fines, or criminal offences. It is an evidentiary instrument made under subsection 196B(2) of the VEA (Authority, s3) and is expressed to apply to particular statutory claim pathways (Application, s5). The instrument’s mechanism is regulatory and evidentiary rather than punitive.

Enforcement in the ordinary sense is carried out via the claims and assessment processes under the VEA and MRCA. The instrument supplies the list of factors and linkage rules (s9, s10) that will be used in entitlement determinations. Where a claimant adduces evidence meeting the instrument’s requirements, the claims decision process will proceed in accordance with the applicable provisions of the VEA or MRCA. The instrument itself does not prescribe administrative sanctions for non‑compliance or false statements. Any sanctions or penalties that might attach to dishonest claims or procedural non‑compliance would derive from the underlying Acts, not from this Statement of Principles. The instrument does not identify any referral powers to other agencies for investigation.

Operational effect on enforcement and review. Because the instrument defines the minimum factors required to raise a reasonable hypothesis, it changes the evidentiary threshold decision makers must apply when considering whether further investigation or acceptance of a claim is triggered. In that sense, it affects the administrative "enforcement" of entitlement rules by narrowing or clarifying the triggers for further action. The instrument also cross‑references other Statements of Principles where s9 factors implicate other injuries or diseases (s11), making it necessary for assessors to apply potentially multiple SOPs in an assessment.

Relevance of repeal. The instrument expressly repeals the prior Statement of Principles concerning sarcoidosis (No. 59 of 2016) (Repeal, s4). Repeal is a change in the body of evidentiary guidance available to assessors. The instrument does not itself specify transitional arrangements for claims that were pending under the prior SOP; the text simply repeals the prior instrument and introduces the new one with effect from its commencement date (s2, s4).

No compliance notices or reporting obligations. The instrument does not include notice, reporting, or compliance obligations for medical practitioners, hospitals, or other service providers. The duties imposed by the instrument are focused on the content of claim assessments and the evidentiary elements required to raise a reasonable hypothesis for the purposes of entitlement determinations under the VEA and MRCA.

The instrument sits within the statutory architecture of veteran entitlements and military compensation. It was made by the Repatriation Medical Authority under subsection 196B(2) of the Veterans' Entitlements Act 1986 (Authority, s3), and it applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (Application, s5). Those cross‑references anchor the instrument to the relevant statutory claims frameworks. The Schedule defines VEA and MRCA as terms used in the instrument (Schedule 1 - Dictionary).

Cross‑references to other Statements of Principles. Section 11 expressly provides for interaction with other Statements of Principles determined under subsection 196B(2) of the VEA. If a factor in s9 refers to an injury or disease that is the subject of a different SOP, then the factors in that other SOP apply to the claim in accordance with the other SOP’s terms (s11(1)-(2)). That is a direct statutory cross‑application rule. Practically, it requires claim handlers to identify relevant overlapping SOPs and to apply their factors consistently.

Interaction with medical classification systems. The instrument refers to ICD‑10‑AM coding, noting sarcoidosis attracts ICD‑10‑AM code D86, but clarifies that the statutory meaning of sarcoidosis for the instrument is the definition in s7(2) and that references to ICD‑10‑AM are to the edition specified in the text (s7(2)-(3)). Therefore, while ICD coding may be used as a descriptive or classificatory aid, the legal meaning is textual and not solely dependent on the coding system.

Operational link to the VEA and MRCA claims processes. Because the instrument applies to claims under specified provisions of the VEA and MRCA (s5), it will be used as the medical standards instrument for determining whether a "reasonable hypothesis" exists for sarcoidosis claims. The precise procedural consequences, such as whether an acceptance of reasonable hypothesis triggers presumptions, evidentiary reversals, or entitlement decisions, are governed by the VEA and MRCA themselves; this instrument is an evidentiary input to those statutory decision processes. The instrument does not purport to alter the statutory rights of review, appeal, or administrative processes established by the VEA or MRCA.

No other domestic laws are mentioned in the instrument. The instrument does not purport to modify criminal law, workplace health and safety law, or other regulatory regimes. Its purpose is confined to the medical and evidentiary determination of causal nexus between sarcoidosis and relevant service as part of the VEA and MRCA entitlement systems.

Temporal application and repeal interaction. The instrument repeals the prior SOP from 2016 (Repeal, s4) and commences on 21 July 2025 (s2). The instrument does not specify transitional arrangements for claims pending at the time of repeal and commencement. Interaction with transitional provisions, if any, would therefore depend on administrative practice or other statutory provisions external to this document. The text does require the application of the newly stated factors and the linkage rule from its commencement.

Scope boundaries created by definitions. The Schedule’s definition of relevant service sets the boundaries of which service categories will cause the instrument to be engaged (Schedule - relevant service). The definition of terminal event in the Schedule governs how deaths where sarcoidosis contributed to listed causes are treated under the instrument (Schedule - terminal event). Those definitional choices determine the instrument’s intersection with the substantive VEA and MRCA eligibility categories.

In sum, the instrument is an evidentiary tool that integrates into the VEA and MRCA frameworks by supplying a medical standard and list of relevant factors, cross‑applying where other SOPs cover implicated injuries or diseases, and anchoring its remit to the statutory categories defined in the Schedule.

The instrument contains a short, discrete amendment history within its own text. It expressly repeals the prior Statement of Principles concerning sarcoidosis (Reasonable Hypothesis) (No. 59 of 2016) (Federal Register of Legislation No. F2016L01144) that had been made under subsections 196B(2) and (8) of the VEA (Repeal, s4). The current instrument is titled Statement of Principles concerning sarcoidosis (Reasonable Hypothesis) (No. 60 of 2025), dated 20 June 2025 and scheduled to commence on 21 July 2025 (Authority, s3; Commencement, s2; front matter).

What the instrument records about its provenance. The instrument is made under subsection 196B(2) of the VEA (Authority, s3), and the front matter shows the Repatriation Medical Authority Chairperson signed on behalf of the Authority. It includes the formal contents list and the Schedule. The instrument’s basis statement records the RMA’s view it has "sound medical‑scientific evidence" supporting the factors included (Basis for determining the factors, s8).

No other amendments, historical versions, or modification dates are recorded within the instrument beyond the repeal of the 2016 SOP and the commencement date for this instrument. The text does not include transitional provisions, savings clauses, or retroactivity statements with respect to decisions made under the prior SOP. It also does not record any minor corrections or technical amendments beyond replacement of the prior SOP by repeal.

Therefore, the amendment history in the text is confined to the repeal of the 2016 instrument and the creation and commencement of the 2025 instrument. Any further amendment history after commencement would be recorded in subsequent legislative or administrative instruments outside this text.

The instrument itself does not record any litigation history. There are no judicial decisions, appeals, or disputes referenced in the text. The document simply states that it was determined by the Repatriation Medical Authority under subsection 196B(2) of the VEA and provides the operative provisions for application to claims under s120A of the VEA or s338 of the MRCA (Authority, s3; Application, s5).

Because the instrument is an evidentiary Statement of Principles, any litigation that might arise would be external to the instrument and would take place within the appeal and review processes established by the VEA and MRCA, or in the courts or tribunals that hear challenges relating to decisions under those Acts. The instrument does not itself provide information about such proceedings, nor does it list any cases. The Schedule and main text likewise do not record any history of legal challenges to prior Statements of Principles, including the 2016 SOP that this instrument repeals.

What is present in the text that bears on potential disputes. Section 8 records the RMA’s view that there is sound medical‑scientific evidence indicating a connection between sarcoidosis and relevant service (Basis for determining the factors, s8). A party dissatisfied with how that view is applied to their claim may seek a review or appeal under the VEA or MRCA processes, and may challenge factual findings about whether a s9 factor exists, whether it is related to relevant service per s10(1), or whether the clinical worsening rule in s10(2) applies. The instrument does not specify the procedural avenues for such challenges, because those are contained in the VEA and MRCA.

In short, the instrument contains no record of litigation, and any litigation related to its operation will arise in the external statutory review and appeal mechanisms to which it applies. The text itself is silent on past or pending litigation.

The instrument is compact, but it contains several textual features and definitional choices that can cause practical or legal pitfalls if they are overlooked. These are matters a practitioner should note when advising claimants or preparing evidence.

1. Temporal windows are tight and specific. The listed medications in s9(1) must have been taken within five years before clinical onset or clinical worsening. By contrast, antiretroviral treatment for HIV and organ or tissue transplant from a donor with sarcoidosis carry two year windows (s9(2)-(3)). Practitioners must establish precise dates for medication use, clinical onset, clinical worsening, and transplant events. The instrument’s thresholds are absolute in their wording, so evidence must align with the specified windows.

2. Categorisation of medications is by drug classes with illustrative examples in the notes to s9. The instrument gives examples (for instance, BRAF/MEK inhibitor drugs include dabrafenib, lorlatinib, trametinib, and vemurafenib; immune checkpoint inhibitors include ipilimumab, nivolumab, and pembrolizumab; interferons include interferon alpha, interferon beta, peginterferon alpha, and peginterferon beta). These notes are part of the instrument’s text, but they are illustrative and the primary legal test is the class listed in s9(1). Practitioners should ensure the precise identity and timing of drugs are recorded, and not rely solely on brand names or informal descriptions.

3. The "clinical worsening" concept is limited. Section 10(2) makes clear that clinical worsening aspects of s9 factors apply only where the sarcoidosis was suffered or contracted before or during, but did not arise out of, the relevant service. That is a nuanced limitation. In practice, if sarcoidosis is alleged to have arisen out of service (that is, it is service‑caused), the clinical‑worsening pathway in s10(2) does not operate in the same way. Practitioners must identify whether the claimant’s sarcoidosis is pre‑existing, contracted before or during (but not due to) service, or arose out of service. The instrument requires that the factor be "related to the relevant service" per s10(1), which is a separate linkage test.

4. "Inability to obtain appropriate clinical management" is a factor, but it is undefined. Section 9(4) lists inability to obtain appropriate clinical management for sarcoidosis before clinical worsening as a factor. The Schedule does not define "appropriate clinical management." That creates an evidentiary and interpretative gap. Practitioners will need to articulate and prove what constituted "appropriate clinical management" in the claimant’s circumstances and why it was unavailable, and show how that inability temporally preceded clinical worsening. The instrument provides no checklists or standards for what is appropriate.

5. Cross‑referencing to other SOPs can create complexity. Section 11 instructs assessors to apply factors in other SOPs where a s9 factor refers to an injury or disease covered by another s196B(2) SOP. Practically, this means the presence of cross‑referenced conditions can require the application of multiple SOPs in a single claim. Practitioners must identify which other SOPs are engaged and ensure consistency between their factual narratives and the factors in those other SOPs.

6. Death cases require linking a terminal event to sarcoidosis. The instrument treats death from sarcoidosis as including death from a terminal event or condition to which sarcoidosis contributed (s7(4)). The Schedule lists examples of terminal events. In death cases, practitioners should adduce evidence connecting the sarcoidosis to the proximate or ultimate causes listed as terminal events. A mere presence of sarcoidosis on the death certificate will not, on its own, demonstrate the required causal contribution unless the medical evidence ties sarcoidosis to the terminal event.

7. ICD‑10‑AM coding is not determinative of legal meaning. The instrument notes that while sarcoidosis attracts ICD‑10‑AM code D86, the statutory meaning is the definition in s7(2), and references to ICD‑10‑AM are to the edition specified (s7(3)). Practitioners should use coding for classification and retrieval, but rely on clinical descriptions and the s7(2) definition when framing arguments.

8. Repeal and commencement dates matter for pending claims. The instrument repeals the 2016 SOP (s4) and commences on 21 July 2025 (s2). The text does not specify transitional arrangements for claims started under the earlier SOP. Where timing of claim lodgement, medical evidence dates, or administrative actions straddle the repeal and commencement, practitioners should check administrative policies and any guidance from the administering agency about application to pending matters.

9. Relationship to relevant service is an express requirement. Section 10(1) insists that the existence of any factor in s9 "must be related to the relevant service rendered by the person." The Schedule defines relevant service in specific categories. This is not a mere temporal coincidence test; the instrument embeds a relationship requirement. Practitioners must frame evidence to show that the listed factor is connected to the claimant’s particular service circumstances as defined in the Schedule.

10. No definition of "reasonable hypothesis" in the instrument. The instrument uses the standard "reasonable hypothesis" in s9 but does not define it. The practical consequence is that assessors will have to apply the statutory or administrative interpretation of that standard in the claims context. Practitioners should therefore provide clear, cogent, and temporally precise evidence showing how a listed factor raises a plausible link to service, because the instrument sets minimum factual predicates rather than a mechanistic presumption.

Those ten items capture the principal textual places where misreading or omission of evidence will produce difficulties in advancing or defending claims that sarcoidosis or death from sarcoidosis is related to relevant service.

Compliance with this Statement of Principles, insofar as it affects claim preparation and assessment, is primarily about assembling and presenting the medical and service evidence that corresponds to the instrument’s listed factors and linkage rule. The following steps flow directly from the instrument’s text and are practical, evidence‑focused actions to satisfy the minimum requirements the instrument establishes.

1. Identify the statutory claim pathway and confirm relevant service. Confirm that the claim is one to which section 120A of the VEA or section 338 of the MRCA applies, so that this SOP is the appropriate evidentiary instrument (Application, s5). Establish which category of relevant service applies by reference to the Schedule’s definition of relevant service, and document service records accordingly (Schedule - relevant service).

2. Establish clinical onset and clinical worsening dates. The temporal windows in s9 pivot on "clinical onset" and "clinical worsening." Obtain and document medical records that state or enable reliable determination of the dates of initial clinical presentation and any subsequent worsening. These dates determine whether medication exposure or other factors fall within the five year or two year windows in s9.

3. For medication‑based factors (s9(1)), assemble medication histories. If relying on the s9(1) medication classes, obtain prescriptions, hospital pharmacy records, treatment notes, and specialist correspondence showing the exact drug names, doses, and dates of use. The instrument specifies classes of drugs and gives examples; ensure the evidence establishes use of drugs within the relevant class and the timing within five years before clinical onset or worsening. Where a listed drug is not one of the notes’ examples, provide pharmacological information that demonstrates it belongs to the specified drug class.

4. For HIV antiretroviral treatment (s9(2)), document treatment timing and HIV diagnosis. Obtain records from infectious diseases specialists, general practitioners, or hospital charts that show antiretroviral therapy was administered within two years before clinical onset or clinical worsening. Include regimen names and dates.

5. For transplantation from a donor with sarcoidosis (s9(3)), obtain transplant and donor information. Secure transplant operation reports, donor screening or pathology reports indicating donor sarcoidosis, and dates of the transplant. The instrument excludes corneal transplants; ensure tissue type is recorded.

6. For inability to obtain appropriate clinical management (s9(4)), compile contemporaneous evidence of attempts to access care. Given the Schedule does not define "appropriate clinical management," assemble correspondence, referral refusals, wait‑list evidence, geographic access data, and treating clinician opinions explaining why recommended or standard treatments were unavailable before clinical worsening. Where appropriate, obtain expert medical opinions linking lack of access to subsequent clinical worsening.

7. Link the chosen factor to relevant service (s10(1)). The instrument requires the factor relied upon to be "related to the relevant service rendered by the person." Prepare evidence connecting the factor to service circumstances. For example, if inability to obtain appropriate clinical management is attributed to being deployed in a particular theatre or location, document dates, locations, and medical availability in that theatre, and link those to the declared relevant service period. If a medication exposure occurred as part of service medical treatment, obtain service medical records showing that causal chain.

8. Address the "clinical worsening" limitation carefully (s10(2)). If invoking clinical worsening as the basis for a factor, confirm that the sarcoidosis was suffered or contracted before or during, but did not arise out of, the relevant service. Prepare medical evidence that establishes the pre‑existing or service‑concurrent nature of the disease and expert opinion that the s9 factor materially contributed to or aggravated the sarcoidosis.

9. Identify and apply any cross‑referenced SOPs (s11). If any s9 factor refers to another injury or disease covered by a separate Statement of Principles, identify that instrument and apply its factors as required. Gather the additional medical evidence necessary under that other SOP.

10. Use the statutory definition of sarcoidosis rather than relying exclusively on ICD coding (s7(2)-(3)). While ICD‑10‑AM code D86 is noted, the instrument’s legal meaning of sarcoidosis is the textual medical definition in s7(2). Ensure clinical summaries and expert reports describe the pathophysiology in terms consistent with that definition, and use ICD coding as supplementary classification.

11. Prepare expert medical reports that address causal contribution. Given the instrument sets the factors that raise a reasonable hypothesis and the RMA records an evidentiary basis for those factors (s8), obtain medical expert reports that evaluate whether the asserted factor is present, whether it falls within the specified temporal window, and whether it is related to the claimant’s relevant service. Where death is involved, ensure the expert explains how sarcoidosis contributed to the terminal event listed in the Schedule.

12. Maintain documentary chains for drug exposure and transplantation. For medications and transplants, maintain contemporaneous prescribing or procedural documentation linking the exposure to the claimed time period. Where records are incomplete, corroborative evidence such as pharmacy dispensing records, specialist letters, or contemporaneous notes will assist.

13. Anticipate and address the undefined elements. The Schedule does not define "appropriate clinical management" or "reasonable hypothesis." Prepare medico‑legal submissions that define these concepts in the claimant’s context and explain why the available evidence meets the instrument’s thresholds.

14. Track commencement and repeal dates for transitional cases. For claims straddling the repeal of the 2016 SOP and commencement of this instrument, document the dates of critical events and seek administrative guidance where necessary about which SOP applies if the claims process was initiated under the prior SOP (Repeal, s4; Commencement, s2).

15. Keep a checklist keyed to statutory provisions. Align the evidence to s9 and s10, and to the Schedule’s definitions. This ensures that evidence addresses the instrument’s discrete requirements rather than relying on general statements about sarcoidosis.

These steps follow directly from the instrument’s text. They focus on producing the specific factual proof the instrument requires, establishing temporal compliance with its windows, and linking the factor to relevant service as defined in the Schedule. The instrument’s lack of definitions for some terms increases the need for detailed, contemporaneous medical records and cogent expert evidence that addresses the instrument’s textual standards.