Statement of Principles concerning scrub typhus (Balance of Probabilities) (No. 78 of 2018)

The SoP is structured around a small set of legal-technical concepts that determine when scrub typhus is connected to service for claims purposes. The core concepts are:

• Scrub typhus (disease definition): Defined as the clinical illness caused by Orientia tsutsugamushi (s 7(2)). Although the instrument notes the ICD‑10‑AM code A75.3 (s 7(3)), it expressly sets the meaning by the clinical definition in subsection 7(2). This makes the clinical aetiology the operative definition for application of the SoP rather than relying solely on coding (s 7(3)-(4)).

• Death from scrub typhus: The SoP extends to death “from a terminal event or condition that was contributed to by the person's scrub typhus” (s 7(5)). The Schedule defines “terminal event” with an inclusive list (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) which illustrates how common terminal mechanisms are captured (Schedule 1). The statutory text therefore contemplates both proximate and ultimate causes where scrub typhus materially contributes.

• Exposure: “Being exposed to Orientia tsutsugamushi” is defined comprehensively in the Schedule and includes: (a) bite by an infected trombiculid mite (chigger); (b) being in an area endemic for scrub typhus; (c) percutaneous exposure to contaminated blood; and (d) receiving contaminated blood products or stem cell transplant (Schedule 1). The Schedule also defines “area endemic for scrub typhus” to include Africa, the Middle East, South America, Islands of the Pacific and the tsutsugamushi triangle extending to northern Australia (Schedule 1). Exposure is thus not limited to a confirmed mite bite.

• Temporal window for exposure: The SoP requires that exposure to Orientia tsutsugamushi occurred within 28 days before the clinical onset of scrub typhus (s 9(1)). The 28‑day window operates as a proximate incubation/timing requirement for the exposure pathway.

• Ability to obtain appropriate clinical management: The alternative factor in s 9(2) is “inability to obtain appropriate clinical management for scrub typhus”. The instrument does not define this phrase within the Schedule. Section 10(2) restrains the application of this factor to material contribution to, or aggravation of, scrub typhus where the scrub typhus was suffered or contracted before or during (but did not arise out of) relevant service. In other words, the inability-to-treat factor chiefly addresses situations where service materially worsened an existing condition through lack of appropriate care.

• Relevant service: Defined in the Schedule as eligible war service (other than operational service) under the VEA; defence service (other than hazardous service and British nuclear test defence service) under the VEA; or peacetime service under the MRCA (Schedule 1). The SoP therefore applies to claims from veterans or members whose service falls into one of the categories specified.

• Standard of proof and scope: The instrument is expressly styled and framed on the balance of probabilities (title and s 8). The RMA states its view that the medical-scientific evidence renders it “more probable than not” that scrub typhus and death from it can be related to relevant service (s 8).

• Interaction with other SoPs: Section 11 provides that if a factor in section 9 refers to an injury or disease covered by another SoP, then the factors in that other SoP apply in accordance with its terms as in force (s 11). This creates a mechanism for cross-reference and ensures that overlapping disease pathways will be resolved by reference to the relevant instrument.

These concepts together create the legal threshold for causal connection: a disease definition tied to the organism, defined exposure pathways and a short temporal window for exposure, plus an alternative path based on inability to obtain appropriate clinical management limited to particular factual scenarios, all connected back to the statutory categories of “relevant service”.

This SoP affects three categories of actors directly, as determined by the instrument’s text and its stated application.

• Claimants (veterans and members): The SoP applies to “a claim to which section 120B of the VEA or section 339 of the MRCA applies” (s 5). While the instrument itself does not reproduce those sections, the explicit application ties the SoP to the populations who pursue claims under those statutory provisions. The Schedule defines “relevant service” to include certain classes of VEA and MRCA service (Schedule 1). Practically, claimants who suffered scrub typhus (as defined in s 7(2)) or died from a terminal event to which scrub typhus contributed, and who render a claim under the specified statutory provisions, will be directly affected because the presence or absence of the factors in section 9 governs the legal finding of connection.

• Decision‑makers administering VEA and MRCA claims: The RMA made this instrument under its statutory authority (s 3). The SoP supplies the medical-factual rules that decision-makers must apply when determining whether scrub typhus is connected to relevant service for the specified kinds of claims. Section 11 further requires that decision-makers apply other SoPs where factors cross-reference injuries or diseases covered by those SoPs. Thus administrators and reviewers who adjudicate claims will need to interpret and apply the definitions in Schedule 1 (for example “being exposed to Orientia tsutsugamushi” and “terminal event”) and the timing and relation-to-service requirements in sections 9-10.

• Medical authors and experts: The instrument relies on clinical concepts (incubation period, clinical onset, terminal events and clinical management). Medical evidence will therefore be generated and presented to satisfy or dispute the factual predicates set down in the SoP. Experts will be asked to opine on whether exposure occurred within 28 days of onset (s 9(1)), whether a person was in an endemic area (Schedule 1), whether scrub typhus contributed to a terminal event (s 7(5)), and whether the person suffered an inability to obtain appropriate clinical management (s 9(2), s 10(2)). The lack of a precise statutory definition of “appropriate clinical management” makes clinicians’ interpretations consequential.

There are also secondary effects:

• For claimants who were in geographic areas identified as endemic in the Schedule (which expressly includes northern Australia), the exposure factor can be satisfied by “being in an area that is endemic for scrub typhus” (Schedule 1). This reduces the doctrinal necessity of establishing a bite or laboratory confirmation where the timing and clinical onset align.
• For service medical officers and administrative staff, the SoP places a practical requirement to document clinical onset dates and any obstacles to receiving appropriate clinical management while in service when those circumstances arise, because s 9(2) and s 10(2) depend on those facts.

Who does not get affected directly by this instrument: the SoP does not create criminal penalties, financial entitlements by itself, or operational policy. It is a determinative medical-guidance instrument for the statutory claims processes referenced in s 5.

The instrument is not a statute that imposes administrative duties in generic terms. Rather, it prescribes the factual and medical conditions to be established for a finding of connection between scrub typhus (or death from it) and a person’s relevant service. The key operative duties and rights arising from the instrument are therefore conditional and decisional.

Rights and decision rules:

• Claimants seeking recognition that their scrub typhus is connected to relevant service have, under this instrument, the right to have their claim assessed by applying the factors in section 9 and the definitions in Schedule 1. The applicable standard is the balance of probabilities, as expressed by the instrument’s title and s 8 which states the RMA’s view that it is “more probable than not” that scrub typhus can be related to relevant service (s 8).
• If a claimant can establish at least one factor in s 9, and that factor is related to the claimant’s relevant service (s 10(1)), then the threshold set by this instrument for service connection is met for the purposes of the specified claim types.

Duties for decision-makers:

• Decision-makers must apply the factors in section 9 as the necessary predicates for connection. They must determine whether exposure occurred within 28 days before clinical onset (s 9(1)) or whether there was an inability to obtain appropriate clinical management that materially contributed to or aggravated scrub typhus consistent with s 10(2) (s 9(2), s 10).
• When a factor in s 9 refers to an injury or disease covered by another SoP, the duty is to apply that other SoP’s factors “in accordance with the terms of that Statement of Principles as in force from time to time” (s 11). This means decision-makers must cross-check co‑existing SoPs rather than apply the scrub typhus SoP in isolation.

Evidentiary duties and practical obligations:

• The instrument’s temporal and exposure requirements create a duty on claimants to provide evidence that shows timing (clinical onset date), exposure (for example evidence of being in an endemic area within the 28‑day window, evidence of a bite, laboratory confirmation, or documented transfusion), and, when relying on s 9(2), evidence of lack of access to appropriate clinical management and that the scrub typhus pre‑existed or was contracted before or during service (s 10(2)).

Unspecified or discretionary elements (areas where duties are not precisely fixed):

• The phrase “inability to obtain appropriate clinical management” is not defined; the instrument leaves its content to interpretation by decision-makers and medical evidence (s 9(2), s 10(2)). This creates discretion in determining what counts as “appropriate” and what level of inability suffices to meet the factor.
• The instrument refers to “contributed to” for deaths (s 7(5)), which requires a factual assessment of contribution rather than an automatic link. How contribution is established is left to adjudication informed by medical opinion.

No express penalty or enforcement mechanism is included in the SoP. The SoP’s “duties” are the obligations on decision-makers and claimants to apply and meet the specified medical-factual preconditions when determining service connection in claims falling under the VEA/MRCA provisions cited in s 5.

The Statement of Principles itself contains no penalty provisions, fines, criminal offences or administrative sanctions. It is a determinative medical instrument used to assess causation in claims under the VEA and MRCA frameworks. The instrument’s enforcement and effect are therefore indirect: compliance is enforced through application in the statutory claims processes to which it applies.

Concrete enforcement mechanisms and limits that appear in the text:

• Application to claims: Section 5 specifies the SoP applies to a claim to which section 120B of the VEA or section 339 of the MRCA applies. The SoP operates as a binding or guiding medical standard for decision-makers when they adjudicate those claims; it is not a standalone enforcement instrument (s 5).
• Determination standard: The instrument is framed on the balance of probabilities (title; s 8). The RMA states it is of the view, on the sound medical‑scientific evidence available, that it is more probable than not that scrub typhus and death from it can be related to relevant service (s 8). That sets the evidentiary threshold for causation decisions rather than imposing sanctions.

What is not present in the instrument:

• No prescription for penalties for false claims, contempt, or non‑compliance with the SoP is set out in this instrument. Any sanctions relating to misrepresentation or offences would need to be found in the VEA, MRCA or other general legislation, not in this SoP itself. The SoP does not purport to create or allocate financial entitlements; it sets the medical causation framework that feeds into those statutory entitlement determinations.

Practical enforcement implications:

• The practical effect of the SoP will be felt through claims determinations. Decision-makers who accept that a claimant meets one of the section 9 factors, and that the factor is related to relevant service under section 10, will treat the SoP as satisfied for the purposes of the relevant statutory claim process. Conversely, where the requisite factors are not established, decision-makers will find that the SoP does not support service connection.
• Because the SoP leaves certain elements to factual adjudication (for example, what constitutes “appropriate clinical management” and whether scrub typhus “contributed to” a terminal event), enforcement will involve evaluation of medical and factual evidence rather than mechanical application of sanctions.

In summary, enforcement occurs in practice through the adjudicative machinery of the VEA/MRCA claims processes (to which the instrument applies), not through penalties embedded in the SoP itself. The instrument provides the criteria that decision-makers use to admit or reject a causal link in claims, and therefore shapes entitlement outcomes indirectly.

The instrument is made under and expressly linked to the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). The SoP interacts with other laws and instruments in the following ways, as stated in its text:

Statutory basis and application

• Authority: The instrument is made under subsection 196B(3) of the VEA (s 3). Its legal function is to determine the Statement of Principles for scrub typhus under that subsection. Because it is created under the VEA’s mechanism for SoPs, its practical application is within the VEA/MRCA claims architecture.
• Application to claims: The SoP is expressly applied to “a claim to which section 120B of the VEA or section 339 of the MRCA applies” (s 5). The instrument therefore operates as the medical causation standard for those particular statutory claim pathways. The instrument itself does not reproduce the contents of those sections; it simply indicates the statutory contexts in which the SoP must be applied.

Interaction with other Statements of Principles

• Cross-SoP application: Section 11 provides a specific rule for overlap with other SoPs. If a factor in section 9 applies and that factor refers to an injury or disease covered by another SoP made under subsection 196B(3) of the VEA, then “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” (s 11). This creates a hierarchical or coordinating mechanism whereby the specific SoP for the other injury/disease governs the detailed application for that element. It requires decision-makers to check and apply other SoPs where cross references exist.

References to diagnostic coding

• ICD‑10‑AM: The instrument notes that scrub typhus attracts ICD‑10‑AM code A75.3 (s 7(3)), and defines references to ICD‑10‑AM codes as being to the Tenth Edition, effective 1 July 2017 (s 7(4)). However, subsection 7(3) clarifies that, for the purposes of application, the meaning of scrub typhus is that given in subsection 7(2) (the clinical definition). The interaction here is technical: coding is acknowledged but does not supplant the clinical definition.

Definitions that connect to other legislation

• MRCA and VEA abbreviations: The Schedule 1 defines MRCA and VEA as the Military Rehabilitation and Compensation Act 2004 and the Veterans' Entitlements Act 1986 respectively (Schedule 1). The Schedule also defines “relevant service” by reference to categories established under the VEA and MRCA (Schedule 1). Thus, the SoP embeds within itself a cross-reference to the definitions and service classes that are governed by those parent statutes.

What the instrument does not do with respect to other laws

• The SoP does not purport to alter substantive entitlement law in the VEA or MRCA or to create independent causes of action; it is a medical determinative instrument that feeds into statutory adjudication. It does not create criminal or administrative offences, nor does it set compensation rates or benefits; those matters remain within the VEA/MRCA framework.

Practical points for decision-makers and claimants

• Where an exposure factor references an injury/disease covered by another SoP, decision‑makers must apply the other SoP’s factors according to that instrument’s terms (s 11). This requires cross-referencing and may involve applying technical definitions and temporal tests from multiple SoPs to a single factual scenario.
• Because “relevant service” is defined by reference to the VEA/MRCA categories in the Schedule, whether the SoP applies to a particular person is dependent on their service classification under those Acts (Schedule 1).

In sum, the instrument is an integrated element of the VEA/MRCA SoP system: it is made under the statutory SoP power, applies to specified claim types, cross-references ICD coding and other SoPs, and relies on the parent Acts’ categories to determine its scope.

This instrument contains its own immediate amendment history within the body of the text. The explicit amendment-related actions recorded are:

• Repeal of earlier Statement: Section 4 states that “The Statement of Principles concerning scrub typhus No. 73 of 2009 (Federal Register of Legislation No. F2009L04044) made under subsection 196B(3) of the VEA is repealed.” Thus the 2018 instrument supersedes and replaces the 2009 SoP.

• Commencement: The instrument commenced on 24 September 2018 (s 2). The date in s 2 establishes when the 2018 SoP became operative and therefore when decision-makers were expected to apply its terms in place of the repealed 2009 statement.

• No other internal amendments are recorded: The instrument does not itself record any subsequent amendments or variations after its commencement. The instrument’s reference to other Statements of Principles being “in force from time to time” (s 11) implies that other SoPs may change independently, and those changes may bear on how this instrument operates where cross‑references apply, but such changes are not recorded within this scrub typhus SoP text.

Implications:

• Repeal of the 2009 instrument means that the textual and definitional elements in the 2018 instrument are now binding for the specified claims. Any differences in definitions, temporal windows (for example the 28‑day exposure window in s 9(1)), or the inclusion of the inability-to-obtain-treatment factor are now the operative law for relevant claims as of the commencement date.
• Because the SoP system is modular, future amendments to other SoPs could affect how section 11 operates in practice (for example if a cross-referenced SoP is modified), but those are external to this instrument.

No further amendment history, transitional arrangements, or savings clauses are contained in the document. The only discrete amendment action recorded in the text is the repeal of the 2009 SoP and the commencement of the 2018 instrument.

The instrument itself does not record any litigation history. It contains no references to judicial decisions, appeals, tribunal rulings, or other litigation materials. The SoP is a medical determinative instrument and the text provided simply sets out the RMA’s determinations and definitions; it does not mention any cases.

Consequences of silence on litigation:

• Because the instrument does not record litigation history, users must treat the document as a policy instrument rather than a synopsis of contested legal interpretations. Any legal or evidentiary disputes about the interpretation or application of the instrument (for example, what constitutes “appropriate clinical management” or the evidential sufficiency of “being in an area endemic”) are left to be resolved in the claims process and, if contested, through the usual administrative review and judicial avenues available under the VEA and MRCA frameworks. The instrument itself provides the criteria that courts and tribunals would apply when assessing whether decision-makers followed the RMA’s determination; it does not provide commentary on prior adjudications.

Practical note for practitioners:

• Because the SoP sets specific factors and definitions, litigation arising from claims will likely focus on fact-finding (timing of exposure and clinical onset, whether scrub typhus contributed to a terminal event, whether appropriate clinical management was unavailable), and the proper application of section 11 where other SoPs are in play. The absence of litigation history in the instrument means those debates and precedents (if any exist) must be sought elsewhere , for example, tribunal or Federal Court decisions applying SoPs under the VEA/MRCA , which are not contained in this document.

In short, there is no litigation history within the instrument; any disputes about its application are to be expected in the administrative and judicial channels available under the VEA and MRCA, rather than reflected in the instrument text.

This SoP contains a number of technical features that can produce practical pitfalls for claimants, decision‑makers, medical witnesses and representatives. These are concrete points of potential misunderstanding or evidentiary difficulty grounded in the instrument’s text.

1. “Being in an area that is endemic” counts as exposure (Schedule 1)

• The Schedule defines “being exposed to Orientia tsutsugamushi” to include “being in an area that is endemic for scrub typhus” (Schedule 1). Because the Schedule’s definition of “area endemic for scrub typhus” explicitly includes northern Australia and the tsutsugamushi triangle (Schedule 1), mere presence in such a location within the 28‑day window (s 9(1)) can satisfy the exposure factor without proof of a bite or laboratory confirmation. Practitioners should expect that geographic presence will often be relied on; precise service locations and dates therefore become critical evidence.

2. Short temporal window for exposure (28 days) (s 9(1))

• The instrument requires exposure within 28 days before clinical onset (s 9(1)). Where clinical onset is uncertain or recorded late, claimants must establish timing. Infections with atypical presentations, delayed diagnosis, or incomplete clinical records may create disputes about whether the 28‑day window is met.

3. “Inability to obtain appropriate clinical management” is undefined and circumscribed (s 9(2), s 10(2))

• The SoP does not define what counts as “appropriate clinical management”, leaving that threshold to interpretation based on medical evidence and adjudicator judgment. Moreover, section 10(2) narrows the application of this factor to material contribution or aggravation where scrub typhus was “suffered or contracted before or during (but did not arise out of) the person’s relevant service”. This means s 9(2) is not a general catch-all for lack of care during service; it specifically addresses pre-existing or pre-contracted disease that is materially worsened by lack of appropriate treatment in service. Practitioners must therefore gather detailed contemporaneous medical records demonstrating both the pre-existing disease and the treatment limitations alleged.

4. Death causation requires contribution, not mere presence (s 7(5))

• The SoP includes death from scrub typhus where death was “contributed to by the person's scrub typhus” (s 7(5)). Contribution must be demonstrated; death from a terminal event (for example pneumonia or cardiac arrest, Schedule 1) will not ipso facto be attributed to scrub typhus unless contribution can be established. Medical causation evidence addressing contribution is therefore essential.

5. ICD code acknowledgement does not replace clinical definition (s 7(3)-(4))

• Although the instrument notes the ICD‑10‑AM code A75.3, subsection 7(3) specifies that scrub typhus “means” the clinical illness described in subsection 7(2). Relying solely on diagnostic codes in claims documentation without addressing the clinical aetiology and the SoP’s factors may be insufficient.

6. Cross‑SoP interactions can complicate causation (s 11)

• If a section 9 factor refers to an injury or disease covered by another SoP, that other SoP applies “in accordance with the terms of that Statement of Principles as in force from time to time” (s 11). Practitioners must be alert to overlapping SoPs and how amendments to other SoPs could affect a given claim. Failure to identify a cross-reference may lead to misapplication of the correct criteria.

7. “Relevant service” is defined narrowly (Schedule 1)

• The Schedule sets out particular categories of service that constitute “relevant service” (eligible war service other than operational service; defence service other than hazardous service and British nuclear test defence service; peacetime service under the MRCA). Whether an individual’s service falls into these categories may be determinative of whether the SoP applies at all.

8. Burden of proof and evidentiary gaps

• The standard is the balance of probabilities, but the SoP creates specific factual predicates. Where records are incomplete (for instance, no documented onset date, no record of being in an endemic area, no transfusion records), meeting the SoP may be difficult even where clinical suspicion is high. The undefined terms and reliance on medical opinion mean administrative adjudication will hinge on the quality of the evidence presented.

9. Repeal of the 2009 SoP may change outcomes (s 4)

• The instrument repeals the 2009 SoP. Practitioners should check whether facts assessed under the old SoP might yield different outcomes under the 2018 text (for example, changes in definitions, time windows, or included factors).

10. No guidance on what constitutes “appropriate” thresholds for laboratory confirmation or diagnosis

• The SoP sets out exposure pathways and timing but does not prescribe what level of laboratory confirmation (if any) is required to establish clinical onset or exposure. Medical opinion will therefore be key, and the absence of lab confirmation may not be fatal where clinical diagnosis and timing meet the SoP’s criteria.

These are operational “gotchas”: the instrument sets tight factual predicates and leaves some critical terms to interpretation. Good practice requires early assembly of service records, contemporaneous clinical notes, precise dates of presence in endemic areas, transfusion histories, and medical expert reports that address the defined factors and the SoP’s constrained applications.

Compliance in the context of this SoP means preparing and presenting the factual and medical material necessary for a decision-maker to find that at least one of the section 9 factors exists and that it is related to the person’s relevant service under section 10. The steps below identify the concrete evidence and approaches that claimants, medical witnesses and decision-makers should adopt to align with the instrument’s requirements.

For claimants and representatives

1. Establish the clinical diagnosis and onset date

• Document the clinical diagnosis of scrub typhus consistent with the SoP’s clinical definition (s 7(2)). Capture the earliest recorded clinical onset date. The 28‑day exposure window (s 9(1)) makes the onset date central to establishing that exposure occurred in the required timeframe.

2. Prove exposure within 28 days before clinical onset (s 9(1); Schedule 1)

• Gather evidence showing exposure to Orientia tsutsugamushi within 28 days before onset. Evidence may include:
  • Service location records, operational logs or travel itineraries placing the person in an area endemic for scrub typhus within the 28‑day window (Schedule 1 defines endemic areas, including northern Australia and the tsutsugamushi triangle).
  • Medical notes documenting a trombiculid mite bite (chigger) or an eschar, which are typical clinical findings listed in the instrument’s note to subsection 7(2).
  • Records of percutaneous exposure to contaminated blood, or transfusion/stem cell transplant documentation where contamination is alleged (Schedule 1).

3. If relying on inability to obtain clinical management (s 9(2), s 10(2))

• Because this factor is limited by s 10(2), establish:
  • That scrub typhus was suffered or contracted before or during (but did not arise out of) relevant service.
  • Contemporaneous medical records, service medical officer notes or other evidence showing that appropriate clinical management was not available or accessible and that this materially contributed to or aggravated the disease.
  • Expert medical opinion explaining the causal pathway between lack of appropriate care and material contribution or aggravation.

4. For death cases (s 7(5); Schedule 1)

• Obtain medical records and expert evidence demonstrating that the death’s terminal event (such as pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function as listed in Schedule 1) was contributed to by scrub typhus. The SoP requires contribution, not mere coincidence; medical opinion should detail how scrub typhus materially contributed to the terminal event.

5. Address cross-SoP issues (s 11)

• Identify whether any factor in a claim overlaps with another SoP. If so, obtain and apply the other SoP’s factors as they are in force, and make submissions explaining how those factors are met with reference to the other instrument.

6. Provide clear chronology and linkage to service categories (Schedule 1)

• Ensure service classification fits the Schedule’s definition of relevant service (e.g. eligible war service, defence service, peacetime service under the MRCA). Provide a clear timeline linking the clinical events to the period of relevant service and to the exposure window.

For medical witnesses and experts

1. Address the SoP factors directly in reports

• Experts should state whether, on the balance of probabilities, exposure occurred within the 28‑day window (s 9(1)), whether lack of appropriate clinical management materially contributed or aggravated scrub typhus (s 9(2), s 10(2)), and whether scrub typhus contributed to any terminal event (s 7(5)).

2. Define “appropriate clinical management” in context

• Given the SoP does not define “appropriate clinical management”, experts should articulate what appropriate care would have been in the circumstances and why the absence of that care led to the asserted material contribution or aggravation.

For decision-makers and administrators

1. Apply the SoP’s factors and Schedule definitions exactly

• Verify that at least one factor in section 9 exists and is related to relevant service per section 10. Use the definitions in Schedule 1 (for example “being exposed to Orientia tsutsugamushi”, “area endemic for scrub typhus”, “relevant service”) to structure findings of fact.

2. Address cross-references to other SoPs (s 11)

• Where a factor invokes another SoP, apply that other SoP’s factors as in force and document how the cross-SoP application affects the decision.

3. Be explicit about causal assessments of contribution for death cases (s 7(5))

• When assessing deaths, record why and how scrub typhus contributed to the terminal event and document the evidentiary basis for that finding.

4. Resolve evidentiary gaps with appropriate medical enquiries

• Where clinical onset is unclear or records are sparse, seek medical clarification, contemporaneous witness statements as to location and presence in endemic areas, and, where necessary, additional expert opinion.

Recordkeeping and practical preparations

• Preserve service records showing exact locations and dates to prove presence in an endemic area.
• Secure transfusion and blood product records where transfusion exposure is alleged.
• Obtain contemporaneous medical notes showing onset, diagnosis and management attempts.
• Where relevant, document efforts to obtain clinical care while in service (for s 9(2) claims), including correspondence or orders indicating inability to treat.

In short, compliance requires aligning documentary and expert medical evidence to the SoP’s narrow factual predicates: a defined clinical diagnosis, a clearly established 28‑day exposure window or documented inability to obtain appropriate clinical management (applied within the limits of s 10(2)), and a clear temporal and causal connection to the Schedule’s definition of relevant service.