Statement of Principles concerning seborrhoeic keratosis (Balance of Probabilities) (No. 20 of 2024)

The instrument revolves around a compact set of legal‑medical concepts that determine how a condition is linked to service. Those concepts are:

• Definition of the condition: The operative legal definition of "seborrhoeic keratosis" for claim purposes is provided in s 7(2). It is defined histopathologically as a benign intra‑epidermal tumour arising from proliferation of basaloid keratinocytes with the architecture of a papilloma with a flat base and hyperkeratotic crown. The definition expressly includes a list of clinical variants such as basal cell papilloma, dermatosis papulosa nigra, pigmented seborrhoeic keratosis, seborrhoeic wart, stucco keratosis and Leser‑Trélat sign/disease (s 7(2)(a)-(b)). The definition explicitly excludes seborrhoeic dermatitis, seborrhoeic psoriasis and solar keratosis (s 7(2)(c)).

• ICD code relationship: The SoP acknowledges that seborrhoeic keratosis attracts ICD‑10‑AM code L82, but declares that for application of the SoP the statutory meaning is the definition in s 7(2) (s 7(3)). The citation to the particular edition of ICD‑10‑AM is specified (s 7(4)).

• Causal standard and burden: The instrument states the Repatriation Medical Authority’s view that, "on the sound medical‑scientific evidence available", it is more probable than not that seborrhoeic keratosis and death from seborrhoeic keratosis can be related to relevant service rendered by veterans or members under the VEA or MRCA (s 8). The title and s 8 set the balance of probabilities as the standard for the relationship.

• Qualifying factors: Section 9 lists the factors that must exist to establish a link with service. For this SoP there is a single enumerated factor: inability to obtain appropriate clinical management before clinical worsening (s 9(1)).

• Relationship to service and temporal limits: Section 10 requires the factor(s) in s 9 to be related to the person's relevant service. Subsection 10(2) further narrows the application of the s 9(1) factor so it applies only to material contribution to, or aggravation of, seborrhoeic keratosis where the person's seborrhoeic keratosis was suffered or contracted before or during (but did not arise out of) the person's relevant service.

• Cross‑reference to other SoPs: Section 11 requires that if a factor in s 9 refers to an injury or disease that is the subject of another SoP, then the factors in that other SoP apply in accordance with its terms as in force from time to time.

• Scope of "death from": Death is included where the person’s seborrhoeic keratosis contributed to a terminal event or condition, with "terminal event" given an enumerated meaning in Schedule 1 (s 7(5); Schedule 1).

• Application and authority: The SoP is made under s 196B(3) of the VEA (s 3) and applies to claims to which s 120B of the VEA or s 339 of the MRCA applies (s 5). The Schedule provides definitions that are used across the instrument, including the statutory meanings of "relevant service", MRCA and VEA.

These concepts operate together to set a tightly framed evidentiary test for service connection of seborrhoeic keratosis and related deaths. The instrument is primarily a rule‑making, definitional and evidentiary document; it does not create operational obligations or penalties within its text, but informs decision‑making in the statutory claims processes to which it applies.

This SoP affects claimants and decision‑makers operating within the statutory framework of the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. More specifically:

• Claimants: The instrument applies to a claim to which s 120B of the VEA or s 339 of the MRCA applies (s 5). Those references identify the statutory claim pathways where a finding of nexus between a condition and relevant service is required. Relevant claimants are veterans and members whose claims fall within those provisions.

• Service categories: The Schedule defines "relevant service" for the SoP 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). Therefore this SoP is targeted at persons whose service is one of those categories. The instrument does not purport to apply to operational service, hazardous service, British nuclear test defence service, or other service types outside the specified categories.

• Medical practitioners and experts: Medical evidence is central. The SoP defines the histopathological meaning of the condition (s 7(2)) and the single qualifying factor concerns clinical management (s 9(1)). As such, treating clinicians, dermatopathologists and medico‑legal experts will be asked to provide records and opinions relevant to the definition and the factor, including evidentiary material about the timing of disease onset, the availability and delivery of clinical management, and whether clinical worsening occurred.

• Decision‑makers and administrators: The Repatriation Medical Authority authored the SoP under its s 196B(3) authority (s 3). Administrative decision‑makers in the claim process who apply the statutory tests under the VEA and MRCA will use this SoP as the RMA’s authoritative statement of the medical factors required to link seborrhoeic keratosis and related deaths to relevant service (s 8-11). Section 11 also imports factors from other SoPs if the s 9 factor refers to a condition covered elsewhere, so administrators must be alert to cross‑references.

• Dependants or estates in death cases: The instrument treats death from seborrhoeic keratosis as including death from a terminal event contributed to by the condition (s 7(5)). Therefore dependants or estates advancing claims based on a deceased person’s service and a terminal event may rely on this SoP to establish a causal contribution where evidence supports it.

• Indirectly affected third parties: Although the SoP itself does not impose regulatory duties on private entities, entities that provide medical services to the affected veteran population may find that their clinical records and capacity to provide "appropriate clinical management" become evidentiary elements in claims. The instrument’s 2015 repeal and replacement also affects practitioners and administrators accustomed to the prior SoP (s 4).

Who pays is not specified in the instrument. The SoP is a determinative statement about medical causation used in the statutory claims framework; any financial entitlements or compensatory arrangements arise under the VEA or MRCA, not from the SoP text itself. The instrument affects evidentiary requirements and thus influences the behaviour of claimants, providers and decision‑makers in those statutory processes (s 5, s 8-11).

The Statement of Principles is not drafted as a schedule of duties imposed on third parties or rights that create standalone entitlements; instead it establishes the medical criteria that must be satisfied for a finding of service connection in relevant claims. The operational duties and rights therefore arise by reference to how the SoP will be applied in the VEA and MRCA claim processes.

• Duty to establish the factor(s): For a claimant to succeed in having seborrhoeic keratosis or death from it accepted as connected with relevant service, at least one of the factors in s 9 must exist (s 9). For this SoP the sole factor is inability to obtain appropriate clinical management for seborrhoeic keratosis before clinical worsening (s 9(1)). The SoP therefore imposes an evidentiary requirement on claimants and their advisors to adduce material demonstrating that the enumerated factor existed in relation to the claimant.

• Duty of relation to service: Any factor relied on must be related to the person’s relevant service (s 10(1)). This means that the qualifying factor is not sufficient in isolation; there must be a factual link between that factor and the person’s relevant service as defined in the Schedule.

• Temporal limitation on application of the factor: Subsection 10(2) confines application of s 9(1) to cases where seborrhoeic keratosis was suffered or contracted before or during the person’s relevant service, but did not arise out of that service. The practical effect is that the s 9(1) factor may be used to establish material contribution or aggravation only for pre‑existing or contemporaneous conditions that were not themselves caused by the service. Claimants and advisers must therefore establish onset timing consistent with s 10(2) if relying on the s 9(1) factor.

• Cross‑application duties: If a factor in s 9 refers to an injury or disease covered by another SoP, then the factors in that other SoP apply as they stand from time to time (s 11). Administrative decision‑makers and claimants must therefore consider other applicable SoPs and ensure that evidence matches the requirements of both instruments where cross‑reference occurs.

• Right to rely on the RMA’s view: Section 8 records the RMA’s scientific view that, on the balance of probabilities, seborrhoeic keratosis and death from it can be related to relevant service. That statement functions as the RMA’s authoritative position on causation for decision‑making under the VEA/MRCA processes. Practitioners and claimants may therefore rely on this SoP as the RMA’s evidentiary framework for contestable decisions about causation.

• Rights in death cases: The SoP expands “seborrhoeic keratosis” to include death from a terminal event or condition that was contributed to by the person’s seborrhoeic keratosis (s 7(5)). Dependants or estates bringing claims based on death must therefore show contribution to a terminal event as defined in Schedule 1 when asserting a service connection.

• Limitations on status conferred by ICD coding: While ICD‑10‑AM coding (L82) is acknowledged, the SoP makes clear that the definition in s 7(2) controls for applications of this instrument (s 7(3)-(4)). The right to have a condition accepted under the SoP therefore depends on meeting the statutory definition rather than merely matching an ICD code.

The instrument itself does not create enforcement mechanisms, monetary penalties, or procedural deadlines. Those matters are governed by the VEA and MRCA claim processes to which the SoP applies. Practitioners must treat the SoP as setting medical content and evidentiary thresholds that determine whether a condition will be accepted as service‑related within those statutory mechanisms.

The Statement of Principles is a determinative medical‑evidentiary instrument; it does not itself create criminal penalties, civil fines or administrative sanctions. The text contains no penalty provisions, sanctioning language, or enforcement mechanisms within the instrument. Its legal effect is to state the Repatriation Medical Authority’s view, for the purposes of the VEA and MRCA claims framework, of what must be established on the balance of probabilities to link seborrhoeic keratosis and relevant deaths to specified categories of relevant service (s 3, s 5, s 8-11).

Consequently, enforcement,meaning the acceptance or rejection of claims, and any attendant financial consequences,lies in the statutory processes under the VEA and MRCA rather than in the SoP text. The instrument:

• Provides the RMA’s authoritative statement of the medical factors to be applied when determining whether seborrhoeic keratosis or death from it is connected with relevant service (s 8-9).

• Does not specify remedial mechanisms, review avenues or penalties for non‑compliance with clinical duties. Those procedural elements are addressed in the primary legislation and administrative practice under the VEA and MRCA, which are referred to in the instrument (s 5; Schedule 1 definitions).

• Imposes no direct regulatory obligations on health providers, though their clinical records and actions may form the factual basis for claims. The instrument’s factor,"inability to obtain appropriate clinical management before clinical worsening",inevitably requires factual inquiry into availability and delivery of clinical care, but the SoP itself does not prescribe sanctions if a provider did, or did not, deliver care.

Because the SoP is confined to medical causation, enforcement of benefits, procedural objections, merits review, and judicial review of decisions remain matters for the administrative and judicial channels established under the VEA and MRCA. The instrument’s repeal of the 2015 SoP (s 4) means that decisions made after commencement will be governed by this text; any procedural consequences flowing from a changed evidentiary threshold must be managed through the existing statutory claim, review and appeal processes specified in the VEA and MRCA, not by punitive provisions in the SoP.

The instrument operates within and by reference to the statutory framework of the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. It establishes medical criteria that are intended to be used in applying those Acts. The interaction points in the instrument are explicit:

• Statutory authority: The SoP is made under subsection 196B(3) of the VEA (s 3). That provision empowers the Repatriation Medical Authority to determine Statements of Principles for medical conditions for the purposes of the VEA. The instrument therefore derives its legal force from the VEA.

• Application to claims: Section 5 states that the instrument applies to a claim to which s 120B of the VEA or s 339 of the MRCA applies. The SoP therefore attaches to the claim pathways and decision points created by those sections. The instrument does not itself restate or alter the procedures in s 120B or s 339; it defines the medical factors to be applied within those procedural frameworks.

• Definitions cross‑referenced: Schedule 1 defines key terms, including MRCA and VEA, and provides the definition of "relevant service" that determines the scope of the SoP. The SoP therefore interacts with and is limited by the statutory concepts of relevant service in the primary Acts (Schedule 1).

• Cross‑application with other Statements of Principles: Section 11 expressly provides that if a factor in s 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 from time to time. This creates an internal statutory‑instrument interaction: SoPs may be read together where factors overlap or refer between conditions. Administrators must therefore check the currency of other SoPs when a s 9 factor engages them.

• Relationship with diagnostic classification: The instrument recognises the ICD‑10‑AM coding system and specifies the particular edition and effective date for the referenced code (s 7(3)-(4)). It clarifies that the statutory definition in s 7(2) controls over mere assignment of an ICD code. Thus, where diagnostic coding and the SoP definition diverge, the SoP’s definition governs the application of this instrument.

• Temporal and causal limits vis‑à‑vis service law: Section 10(2) modifies the way the factor in s 9(1) is applied in relation to timing and causal origin. That provision interacts with statutory tests of causation in the VEA and MRCA because it confines the s 9(1) factor to material contribution or aggravation of a condition that was suffered or contracted before or during (but did not arise out of) relevant service. Decision‑makers must therefore combine the SoP’s temporal/categorical limits with statutory causation tests.

The SoP does not amend or replace the VEA or MRCA themselves. Instead it functions as an evidentiary and definitional tool for the application of those Acts. It does not create obligations that sit outside the VEA/MRCA claim and review processes. Where other laws or standards affect claims under the VEA or MRCA (for example, procedural review rights, compensation schedules or rehabilitation obligations), those laws continue to govern; this SoP supplies the RMA’s medical content to be used within those statutory constructs.

The instrument itself records a brief amendment history limited to the immediate repeal captured in the text. The explicit historical points in the instrument are:

• Date of the instrument: The Statement of Principles is dated 22 February 2024 (front matter). The operative commencement date is 26 March 2024 (s 2). Those are the only temporal markers for this instrument.

• Repeal of prior SoP: Section 4 expressly repeals the Statement of Principles concerning seborrhoeic keratosis No. 56 of 2015 (Federal Register of Legislation No. F2015L00251), which was previously made under subsection 196B(3) of the VEA. The 2015 instrument is therefore no longer in force from the commencement date of this instrument.

• Ongoing currency: Section 11 contemplates that other SoPs may be "as in force from time to time", which implicitly acknowledges that SoPs are subject to later amendment or replacement. The instrument itself, however, contains no schedule of future amendments and no transitional provisions other than the repeal.

• No internal amendment provisions: The instrument does not set out mechanisms for its own amendment, such as sunset clauses, review periods, or automatic revision triggers. Any future amendment or replacement would be effected by a further instrument made under the same statutory power (s 3) and published in accordance with the governing rules under the VEA and the legislative instrument process.

• Scope of change from previous instrument: The instrument does not include a comparative table or commentary explaining how its content differs from the 2015 SoP. The only express historical change is the repeal. Practitioners seeking to understand specific drafting changes between the 2015 and 2024 instruments will need to compare the texts themselves because no amendment history or explanatory memorandum is included in this instrument.

In short, the amendment history recorded in the instrument is minimal: it replaces the 2015 SoP and commences on a specified date in 2024. The instrument anticipates that other SoPs may be updated over time, but contains no further amendment log or transitional regime within its text.

The Statement of Principles instrument contains no references to judicial determinations, cases, or any litigation history. It does not cite precedent, nor does it incorporate any judicial findings into its text. The instrument is purely a statutory administrative instrument made under subsection 196B(3) of the Veterans' Entitlements Act 1986 (s 3), and its content is a statement of the Repatriation Medical Authority’s medical view and the factors to be applied in decision‑making under the VEA and MRCA.

Because the instrument itself provides no litigation history, the text offers no information about any prior judicial treatment of the 2015 SoP that it repeals, or of disputes about causation for seborrhoeic keratosis. The instrument does, however, have an operational function within statutory claim processes (s 5) and therefore will be the basis for administrative decisions that could, in principle, be the subject of merits review or judicial review under the VEA/MRCA regime. The instrument does not identify routes for review or the nature of possible challenges; those procedural matters are located in the primary statutes themselves.

Practitioners should note that the SoP’s absence of litigation references means:

• The text should be read as an administrative‑medical instrument rather than as an embodiment of settled judicial doctrine.

• Any judicial interaction, challenge or interpretation of this SoP will arise in the course of application within VEA/MRCA claim and review processes, not from anything contained in this instrument.

• For specific litigation history or case law addressing application or interpretation of the predecessor 2015 SoP, or of the RMA’s SoPs generally, the instrument provides no guidance; obtaining that history requires consulting external judicial records and the relevant statutory review decisions, which are outside the instrument itself.

This instrument stands as the RMA’s present pronouncement on the matters it covers; the instrument does not record or summarise any actual litigation.

The instrument contains several drafting points and interaction features that can produce procedural or evidential pitfalls for claimants, practitioners, medical witnesses and decision‑makers. The following are the salient items to note, with direct references to the instrument’s text:

• Narrowness of qualifying factors: Section 9 contains a single enumerated factor for seborrhoeic keratosis: "inability to obtain appropriate clinical management for seborrhoeic keratosis before clinical worsening" (s 9(1)). That is a narrow evidentiary gateway. If the claimant cannot demonstrate the specified inability to obtain appropriate management prior to clinical worsening, the SoP requires that the condition is not linked under this instrument, regardless of other circumstances. Practitioners must plan evidence‑gathering around that precise phrase.

• Temporal and causal constraint in s 10(2): The s 9(1) factor "applies only to material contribution to, or aggravation of, seborrhoeic keratosis where the person's seborrhoeic keratosis was suffered or contracted before or during (but did not arise out of) the person's relevant service" (s 10(2)). This is a potential trap:

  • It excludes application where the seborrhoeic keratosis "arose out of" relevant service, even if the disease also involved lack of management. Practitioners must be careful to classify onset correctly and to prepare evidence that situates onset timing and causal origin consistent with s 10(2).

  • The phrase "suffered or contracted before or during (but did not arise out of) the person's relevant service" requires a fine factual analysis. If the condition arose out of service, the pathway under s 9(1) is not available for material contribution or aggravation claims. Claimants must therefore obtain medical opinions that address both onset and causation expressly in the language of the SoP.

• Definition controls over ICD coding: The instrument makes clear that while seborrhoeic keratosis matches ICD‑10‑AM code L82, the meaning of the term for the SoP is the statutory definition in s 7(2) (s 7(3)). If clinical records rely solely on coding without histopathological or clinical evidence matching the s 7(2) definition, the claim risks failure. For example, conditions excluded by the SoP such as seborrhoeic dermatitis, seborrhoeic psoriasis and solar keratosis will not qualify even if mislabelled in coding (s 7(2)(c)).

• Death cases require linkage to a terminal event: The SoP treats death from seborrhoeic keratosis as including death from a terminal event or condition that was contributed to by the person’s seborrhoeic keratosis (s 7(5)). The Schedule defines "terminal event" and provides examples (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). Practitioners must prepare evidence that the seborrhoeic keratosis contributed to the terminal event; simply establishing presence of seborrhoeic keratosis is insufficient.

• Cross‑SoP references: Section 11 requires application of other SoPs when a s 9 factor refers to another condition. Failure to check for and apply the current terms of those other SoPs may result in incomplete or incorrect reliance on the s 9 factor. The instrument states the other SoP’s factors apply "as in force from time to time", so practitioners must ensure they work with the latest versions.

• Repeal of prior SoP without transitional guidance: The instrument repeals the 2015 SoP (s 4) but contains no transitional provisions or comparison. Practitioners who are used to prior drafting must not assume continuity; they should compare the texts where relevant because the present instrument’s single factor may be more restrictive or simply different in approach.

• Burden to show "inability to obtain appropriate clinical management": The s 9(1) factor is phrased in terms of inability to obtain care before clinical worsening. That raises evidentiary questions about what constitutes "appropriate clinical management", how inability to obtain it is demonstrated (for example, system constraints, geographic remoteness, service‑related impediments) and what constitutes "clinical worsening". The SoP does not define those subsidiary terms; establishing them will be a fact‑sensitive exercise in which medical evidence and contemporaneous records will be critical.

• Scope of "relevant service": The Schedule’s definition of relevant service excludes operational service and various hazardous categories as specified; claimants whose service falls outside the stated categories may not be within the SoP’s scope (Schedule 1). Practitioners must confirm the statutory characterisation of service under the VEA/MRCA before relying on this SoP.

• Instrument’s non‑procedural nature: The SoP supplies medical factors but does not instruct on evidence admissibility, procedural timelines, or how decision‑makers must weigh competing medical opinions. Those matters are governed elsewhere. Failure to integrate the SoP’s medical requirements with the procedural rules of the VEA/MRCA could lead to avoidable evidentiary failures.

These points are all grounded in the instrument text. In practice, success under this SoP will depend on precise factual evidence tailored to the instrument’s narrow language, attention to timing and causation, and careful cross‑checking with other SoPs and the statutory characterisation of service.

Compliance in the context of this SoP means preparing and presenting evidence and medico‑legal material that satisfies the RMA’s specified factors and the limits imposed by the instrument. The following actions, drawn from the instrument’s text, indicate what practitioners and claimants should assemble and demonstrate.

1. Confirm eligibility and scope

• Verify that the claim falls under the VEA s 120B or MRCA s 339 claim pathways to which this instrument applies (s 5). Confirm the claimant’s category of "relevant service" as defined in Schedule 1: eligible war service (other than operational), defence service (other than hazardous and British nuclear test defence service) or peacetime service under the MRCA (Schedule 1).

2. Match the medical definition

• Ensure clinical and pathological evidence demonstrates that the condition meets the statutory definition of seborrhoeic keratosis in s 7(2): a benign intra‑epidermal tumour with the histopathological architecture described. Provide histopathology reports or dermatologist opinions that address the specific features in s 7(2)(a).

• If the presentation involves one of the included variants (for example dermatosis papulosa nigra, Leser‑Trélat sign/disease), include targeted clinical descriptions and pathology consistent with the SoP’s list (s 7(2)(b)).

• Exclude conditions listed in s 7(2)(c) from the diagnosis. Where records refer to seborrhoeic dermatitis, seborrhoeic psoriasis or solar keratosis, obtain clarifying reports demonstrating why those diagnoses do not apply.

3. Address the ICD coding but rely on definition

• Acknowledge any ICD‑10‑AM coding in hospital or clinic records, but ensure that medical opinions explain how the pathology meets the statutory definition, because the SoP’s meaning is the definition in s 7(2) notwithstanding the ICD code (s 7(3)-(4)).

4. Prove the qualifying factor(s)

• The sole factor in s 9 is inability to obtain appropriate clinical management for seborrhoeic keratosis before clinical worsening (s 9(1)). Assemble direct and documentary evidence that bears on:

  • What constituted "appropriate clinical management" in the relevant clinical context;

  • Why such management was not obtained, linking that failure to the claimant’s circumstances; and

  • Evidence of "clinical worsening" that occurred after the period when appropriate management was unavailable.

• Documentary sources may include contemporaneous medical records, referral letters, logs showing failed attempts to obtain treatment, communications about service‑related impediments to care, or evidence of system constraints. Expert medical opinions should explain causation and timing in the language of the SoP.

5. Satisfy the temporal/causal constraint in s 10(2)

• If relying on s 9(1) to show material contribution or aggravation, make sure the record establishes that seborrhoeic keratosis was suffered or contracted before or during the relevant service and did not "arise out of" that service (s 10(2)). Obtain medical opinions that explicitly address onset timing, whether the condition arose out of service, and whether the lack of management materially contributed to worsening.

6. Death cases: link to terminal event

• For claims based on death, prepare evidence that the deceased’s seborrhoeic keratosis contributed to a terminal event as defined in the Schedule (s 7(5); Schedule 1 includes examples such as pneumonia and respiratory failure). Provide death certificates, cause of death statements, and medico‑legal opinions that address contribution rather than mere presence.

7. Check cross‑SoP requirements

• If any part of the s 9 factor refers to another condition that is the subject of a different SoP, identify and apply the current terms of that other SoP (s 11). Ensure evidence meets both instruments’ requirements where there is overlap.

8. Use precise phrasing in medical opinions

• Request that medical experts address the SoP elements using its language: histopathological features (s 7(2)), inability to obtain appropriate clinical management and clinical worsening (s 9(1)), temporal relation to service and whether the condition arose out of service (s 10(2)), and contribution to terminal events in death cases (s 7(5)).

9. Anticipate evidentiary limitations

• Because the SoP does not define "appropriate clinical management" or "clinical worsening", be prepared to have medical witnesses set out standards of care relevant to the period and to explain how the claimant’s access to care was inadequate relative to that standard. Where records are sparse, use contemporaneous evidence and credible testimony to establish inability to obtain care.

10. Keep the SoP current

• When preparing evidence, practitioners should ensure they are working with the version of the SoP in force. The instrument itself replaces the 2015 SoP (s 4) and contemplates other SoPs "as in force from time to time" (s 11). Confirm that no subsequent RMA instrument has modified the factors.

In sum, compliance requires aligning the factual record and medico‑legal opinions to the specific statutory language of this SoP. The narrowness of the sole factor and the temporal constraint in s 10(2) make tailored medical evidence addressing onset timing, availability of and access to appropriate management, and objective proof of clinical worsening central to a successful application of this instrument.