Statement of Principles concerning substance use disorder (Reasonable Hypothesis) (No. 59 of 2017)

The central legal concept is the “reasonable hypothesis” standard for causation used in veterans’ claims under the VEA and MRCA. This SOP specifies the clinical definition of substance use disorder and enumerates factors sufficient as a minimum to raise that reasonable hypothesis linking the condition (or death from it) to relevant service.

Key concept elements (with statutory anchor):

• Diagnostic definition: substance use disorder is defined by DSM-5 criteria reproduced in s 7(2). It requires a problematic pattern of substance use producing clinically significant impairment or distress, with at least four of the enumerated criteria within a 12-month period (s 7(2) paragraphs 1-10 and K). Two important qualifications in the diagnostic text: tolerance and withdrawal are not considered met where substances are taken solely under appropriate medical supervision; and the instrument specifically notes that the DSM-5 and substance are defined in Schedule 1 (s 7(2) notes; Schedule 1 DSM-5 and substance entries).
• Exclusions: the SOP includes the explicit note that “The definition of substance use disorder excludes alcohol use disorder and acute substance intoxication in the absence of substance use disorder” (s 7(2) note). This creates a textual separation between alcohol use disorder as an included diagnostic entity in the Schedule’s clinically significant disorders list and the separate definition of substance use disorder in s 7(2).
• Death: death from substance use disorder is included where a terminal event or condition was contributed to by the disorder (s 7(3); Schedule 1 terminal event lists examples such as pneumonia, respiratory failure, cardiac arrest).
• Factors to raise a reasonable hypothesis: s 9 lists 18 discrete factors. They fall into groups:
  • Pre-onset factors: clinically significant disorder of mental health at time of clinical onset (s 9(1)); category 1A and 1B stressors within the five years before clinical onset (s 9(2), (3)); death of a significant other within five years (s 9(4)); medically prescribed substance same pharmacological class as agent of disorder (s 9(5)); severe childhood abuse (s 9(6)); life-threatening medical illness/injury within five years (s 9(7)); category 2 stressor within one year (s 9(8)); persistent pain of at least three months at time of onset (s 9(9)).
  • Worsening factors: the mirror set of factors for clinical worsening of substance use disorder (s 9(10)-(17)).
  • Service delivery factor: inability to obtain appropriate clinical management for the disorder (s 9(18)).
• Temporal windows: many factors have specific temporal bounds , five years for category 1A/1B stressors and death of significant other (s 9(2), (3), (4), (11), (12), (13)); one year for category 2 stressors (s 9(8), (16)); persistent pain defined by duration (Schedule 1 persistent pain).
• Relation to service: every factor must be related to relevant service (s 10(1)). Factors in ss 9(10)-(18) are confined to material contribution or aggravation where the substance use disorder was suffered or contracted before or during, but did not arise out of, the person’s relevant service (s 10(2)).
• Interaction with other SOPs: where a factor in s 9 refers to an injury or disease covered by another SOP, that other SOP’s factors apply as in force (s 11).

The Schedule defines terms that affect application. Notable definitional choices include the inclusion of tobacco in the list of substances; the construction of “corpse” that excludes closed body bag or viewing body in closed casket; the exclusion of media exposure from “eyewitness”; and the broad list of what counts as clinically significant disorders of mental health (Schedule 1). Those definitional choices materially affect what evidence is necessary and what events count as stressors for the temporal tests in s 9.

Mechanically, decision-makers will assess whether the DSM-5 criteria for substance use disorder are met, whether one or more s 9 factors exist within their temporal constraints, and whether those factors are related to the person’s relevant service. If so, the SOP raises the “reasonable hypothesis” that the disorder or death is connected to service for the purposes of s 120A of the VEA or s 338 of the MRCA (s 5). The instrument therefore sits at the interface between clinical diagnosis and administrative causation.

The SOP applies to claimants and decision-makers in the veterans’ compensation and rehabilitation systems: veterans, members of Peacekeeping Forces, and members of the Forces covered by the VEA or MRCA who make claims under provisions identified in s 5 (applications to which s 120A of the VEA or s 338 of the MRCA apply). The Schedule defines “relevant service” with reference to operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike or non-warlike service under the MRCA (Schedule 1 relevant service).

Primary actors affected:

• Claimants: individuals lodging claims that allege substance use disorder or death from substance use disorder. The SOP sets the minimal factors that, if present, will raise a reasonable hypothesis connecting the condition to relevant service (s 9). Claimants seeking to rely on the SOP will need to present evidence addressing the DSM-5 diagnostic criteria (s 7(2)), show that at least one s 9 factor exists within the temporal window, and demonstrate the connection between the factor and relevant service (s 10(1)).
• Medical experts and treating clinicians: the SOP requires clinical evidence for DSM-5 criteria, dates for clinical onset and clinical worsening, evidence of persistent pain, prescribed medications and pharmacological class, and evidence of treatment attempts or failures to obtain treatment (s 7(2), s 9, Schedule 1). The Schedule’s Notes (for example, that “management” may involve regular visits and that “to warrant ongoing management” does not require that any management was actually received) affect the weight and type of evidence clinicians should provide.
• Administrative decision-makers and tribunals: decision-makers under the VEA and MRCA will use this SOP as the medical-scientific determinative instrument setting the minimal factors for a reasonable hypothesis (s 3, s 5). The SOP informs causation assessments in claims involving substance use disorder and death from it.
• Legal advisers and advocates: those who prepare or present claims must translate clinical records into the framework of s 7 and s 9, locate documentary proof of stressors (category 1A, 1B, 2), medical diagnoses, prescriptions, attempts to access care, persistent pain documentation, and history of severe childhood abuse as defined.
• Records-holders: agencies such as the Department of Veterans’ Affairs and Defence, and any hospitals or clinics, are relevant custodians of records that will be marshalled in proving onset, worsening, treatment attempts or stressor exposure. The instrument’s temporal windows implicate the need to locate service records and contemporaneous clinical and psychological documentation.

The SOP’s definitions also broaden who may be implicated in evidentiary inquiries. For example, “significant other” is defined to include close family or close personal relationships (Schedule 1), so evidence from family members and social supports is potentially relevant. The inclusion of tobacco and prescribed medications in the substances list means that claims involving nicotine dependence, prescribed benzodiazepines or opioid analgesics may be captured by the SOP (Schedule 1 substance). Finally, the SOP’s revocation of an earlier SOP (s 4) affects claimants whose claims were assessed under the previous determination, and the compilation notes record an amendment to the dictionary in 2018 (endnotes).

This SOP is an evidentiary instrument and does not itself create statutory rights to benefits or criminal penalties. Its legal effect arises from its operation under the VEA and MRCA (s 3, s 5). The text imposes functional obligations on decision-makers who must use it when considering relevant claims, and it delineates the tests claimants must meet to raise a reasonable hypothesis.

Rights and administrative duties arising from the instrument as given in the text:

• Right to have the issue considered under identified statutory provisions: the instrument applies to claims to which s 120A of the VEA or s 338 of the MRCA applies (s 5). That locates the SOP’s role in the statutory entitlement framework; claimants covered by those provisions have the right to have the SOP applied in assessing whether a reasonable hypothesis exists.
• Duty to relate factors to service: the instrument requires that any factor in s 9 relied upon must be related to the person’s relevant service (s 10(1)). This places a duty on decision-makers to require evidence showing that the stressor, diagnosis, prescribed medication, or other factor is linked to service.
• Duty to treat pre-existing disorders differently: subsections 9(10)-(18) are limited by s 10(2) to material contribution or aggravation where the disorder was suffered or contracted before or during, but did not arise out of, the person’s relevant service. Decision-makers must therefore frame legal causation differently depending on whether the disorder arose out of service or pre-existed it.
• Duty of incorporation with other SOPs: if a s 9 factor refers to an injury or disease already covered by another SOP, the factors in that other SOP apply in accordance with its terms (s 11). Decision-makers must identify and apply the relevant SOPs for any cross-referenced conditions.

Practical implications for duties of practitioners and experts:

• Medical experts have the duty to address the specific DSM-5 criteria set out in s 7(2) and state whether the threshold of four criteria within a 12-month period is met, while noting the instrument’s exclusion for tolerance/withdrawal when substances are taken under appropriate medical supervision (s 7(2) and K).
• Treating clinicians and experts should address timing of clinical onset and clinical worsening, link those dates to any stressor within the windows in s 9, and provide evidence about attempts to obtain appropriate clinical management if s 9(18) is relevant.
• Agencies processing claims have a duty to locate and consider service records and any contemporaneous documentation that bears on the s 9 factors and their relation to service.

Limitations on duties/rights in the instrument:

• The SOP does not itself grant entitlements; it is designed to inform whether a reasonable hypothesis exists for causation. The rights to benefits, compensation or rehabilitation derive from the VEA or MRCA statutory provisions referenced (s 5).
• The instrument does not prescribe evidentiary procedures, burden of proof distribution, or appeal rights; those remain governed by the primary statutes and administrative law.

In sum, the SOP creates a decision-making template and imposes on decision-makers and experts the duty to engage with the discrete diagnostic, temporal and service-related tests it specifies. Claimants have the associated right to have these tests applied to their claim under s 120A of the VEA or s 338 of the MRCA (s 5).

The instrument itself contains no express civil or criminal penalties, sanctions, or enforcement mechanisms. It is a determinative administrative instrument that establishes medical factors to be used when assessing causation in claims under the VEA and MRCA, rather than a statute creating offences.

Enforcement context and mechanisms implicit from the text and statutory relationships:

• Administrative enforcement: The SOP’s practical force is exercised by decision-makers under the VEA and MRCA when they assess entitlement. Compliance with the SOP is therefore enforced administratively through the statutory claim process and internal decision-making practices rather than via criminal sanctions. The instrument does not prescribe specific enforcement steps or remedies; those are found in the governing Acts and administrative law frameworks referenced in s 3 and s 5.
• Evidentiary effect in hearings and appeals: the SOP will be applied by tribunals and courts considering appeals from administrative decisions under the VEA or MRCA statutory regimes. The SOP’s determinations about which factors raise a reasonable hypothesis can be decisive in administrative determinations. The instrument does not itself provide enforcement remedies; any remedy for incorrect application or failure to apply the SOP would arise through review or appeal mechanisms available under the VEA, MRCA or administrative law (not set out in the SOP).
• No sanction for non-compliance in the instrument: the SOP revokes the previous SOP (s 4), and sets definitions and factors, but contains no enforcement provisions such as fines, imprisonment, or administrative penalties for misstatement or non-application. The practical risk of ignoring or misapplying the SOP is that a decision-maker’s reasoning may be vulnerable to review, remittal, or reversal under administrative law principles or statutory appeal mechanisms.

Records and evidentiary duties relevant to enforcement:

• Because the SOP relies on medical and service records, non-availability of records may affect an applicant’s ability to meet the s 9 factors. The SOP does include a factor s 9(18) about “inability to obtain appropriate clinical management for substance use disorder”, which potentially captures situations where health system access issues affect treatment. The instrument does not prescribe how to prove inability to obtain management; that evidentiary question will be an administrative one.

In short, enforcement of the SOP’s prescriptions is exercised through administrative decision-making and any resultant internal or external review mechanisms available under the VEA and MRCA. The instrument contains no internal penalty clauses; its influence is practical and evidentiary rather than punitive.

The instrument is expressly made under subsection 196B(2) of the Veterans' Entitlements Act 1986 (s 3) and applies to claims to which s 120A of the VEA or s 338 of the Military Rehabilitation and Compensation Act 2004 (MRCA) applies (s 5). Its interaction with those Acts and with other SOPs is integral to its operation.

Direct interactions specified in the text:

• VEA and MRCA: s 3 and s 5 position the SOP as the RMA’s determination under the VEA, and its stated application is for the statutory claim gateways in the VEA and MRCA. The SOP provides the medical-scientific backdrop decision-makers under those Acts must apply for substance use disorder causation questions.
• Other Statements of Principles: s 11 sets a rule for cross-references: where a factor in s 9 refers to an injury or disease covered by another SOP, the factors in that other SOP “apply in accordance with the terms of that Statement of Principles as in force from time to time.” This creates a system of interlocking SOPs where a condition that overlaps with another determined disease is assessed by that other instrument’s criteria.
• Definitions linked to other Acts: Schedule 1 defines “relevant service” in terms of categories in both the VEA and MRCA (operational, peacekeeping, hazardous, British nuclear test defence service under the VEA; warlike and non-warlike under the MRCA). This means that the legal characterisation of the claimant’s service under those Acts will determine whether an event is “relevant service” for the SOP’s purposes.

Points of potential complexity in interaction:

• Alcohol use disorder: the instrument’s note in s 7(2) says the definition of substance use disorder excludes alcohol use disorder. Yet Schedule 1’s list of “clinically significant disorder of mental health as specified” includes “alcohol use disorder” among other mental disorders. This creates a textual disjunction that decision-makers must navigate: alcohol use disorder is a recognised clinically significant disorder of mental health for the purposes of s 9(1) and related factors, but alcohol use disorder is explicitly excluded from the SOP’s definition of substance use disorder in s 7(2). The instrument does not resolve this interaction; practitioners must apply the instrument’s text in its entirety and account for those definitions when assessing claims.
• DSM-5 citation: the SOP imports DSM-5 diagnostic criteria (s 7(2)) and defines DSM-5 in Schedule 1. This creates an interaction between Australian administrative law determinations and an external clinical manual. The SOP’s adoption of DSM-5 language fixes the clinical threshold to that edition.
• Cross-SOP reliance: s 11 requires application of other SOPs where s 9 references their covered injuries or diseases. That mechanism means decision-makers must identify when a factor in s 9 refers to another condition and harvest the applicable tests from that other SOP. This could impose multi-instrument evidentiary analysis and create complexity in cases that involve comorbid conditions (for example, PTSD and substance use disorder), as the decision-maker must apply multiple SOPs’ factors.
• Temporal and causation interactions with primary statutes: the SOP requires factors to be “related to the relevant service” (s 10(1)). The statutory tests in the VEA and MRCA for how service-relatedness is legally determined (for example, arising out of service, material contribution, or aggravation) remain defined in the primary statutes and relevant case law. The SOP clarifies medical factors but does not displace the statutory legal tests , instead, it is intended to be applied within those legal frameworks.

Administrative interactions beyond the text:

• The SOP revokes a prior SOP (s 4). Practitioners must therefore consider whether transitional or saving provisions in the amending or primary legislation apply; the compilation’s endnotes caution that uncommenced amendments or application, saving and transitional provisions may affect operation and are not shown in the compiled text (compilation notes).

Overall, the SOP operates as a medical-determinative layer applied in the statutory architecture of the VEA and MRCA and interacts with other SOPs by reference. The instrument fixes diagnostic and temporal thresholds while leaving legal causation questions to be resolved within the primary statutory frameworks.

The compilation records foundational data about the instrument’s creation, commencement, revocation of an earlier instrument, and subsequent amendment history. The SOP was made on 3 November 2017 and commenced on 4 December 2017 (s 2; Legislation history endnote 3). Section 4 expressly revokes the Statement of Principles concerning substance use disorder No. 3 of 2009. The compilation includes amendments up to Veterans' Entitlements (Statements of Principles,Category 1B Stressor) Amendment Determination 2018 (No. 87 of 2018), with a stated day of commencement for that amendment being 24 September 2018 (compilation cover and endnote 3).

Specific amendment entries and their effect as recorded in the compilation:

• Veterans' Entitlements (Statements of Principles,Category 1B Stressor) Amendment Determination 2018 (No. 87 of 2018), registered 28 August 2018, commenced 24 September 2018. The endnotes (Endnote 3,Legislation history and Endnote 4,Amendment history) indicate that Schedule 1 - Dictionary entries for category 1B stressor were repealed and substituted (rs. No. 87 of 2018) and that the Schedule 1 - Dictionary entry for “corpse” was added (ad. No. 87 of 2018). The compilation’s front matter notes that the compilation date is 24 September 2018 and that the compilation includes amendments up to Determination No. 87 of 2018 (Compilation No. 1).
• The compilation notes that uncommenced amendments are not shown in the compiled text and that details of such amendments would be available on the Legislation Register (compilation “About this compilation” notes).
• The endnotes include procedural material about misdescribed amendments and the meaning of the endnotes, and the Abbreviation key (Endnote 2) explains notation used in the amendment history.

Implications for practitioners:

• The revocation of the 2009 SOP (s 4) means that claims must be assessed under this SOP from its commencement date unless transitional provisions in the amending legislation or in the primary statutes provide otherwise. The compilation does not include any transitional provisions in the main text; the front matter signals that application, saving and transitional provisions affecting operation may exist elsewhere and directs readers to the Legislation Register for those details.
• The 2018 amendment to category 1B stressor and the addition/change to “corpse” in the Schedule may alter the range of stressors that meet s 9(3) and the examples that count as a “corpse” under relevant eyewitness/trauma criteria. The compilation records that the category 1B stressor entry was substituted (rs) and “corpse” was added or amended (ad). Practitioners must use the post-amendment text as printed in the compilation and check for any later amendments beyond the compilation date.

The instrument’s endnotes therefore form part of the textual history and indicate post-enactment revisions that affect the meaning of key terms and the content of the Schedule. Users of the SOP should confirm whether any further amendments or uncommenced provisions exist beyond the compilation date by consulting the Legislation Register.

The text of this SOP and the compilation include no case law, judicial determinations, or recorded litigation history. The document is an administrative determination; the compilation’s endnotes give history of the instrument itself and the amendments made to it, but they do not record any litigation applying or construing this particular SOP.

Practical implications of the absence of litigation history in the instrument:

• The SOP is intended to be used by decision-makers and will in practice be referenced in decisions of the Department of Veterans’ Affairs, the Veterans’ Review Board, the Administrative Appeals Tribunal, and courts where appeals of administrative decisions are brought. The compilation does not, however, contain or summarise any judicial consideration of how the SOP should be applied in contested cases.
• Legal advisers relying on precedent must therefore look beyond the instrument text to case law applying the SOP or comparable SOPs to understand evidentiary standards, the weight of medical opinion, the interpretation of terms such as “related to the relevant service,” and how tribunals have treated difficult issues such as the exclusion of alcohol use disorder from the SOP’s substance use disorder definition. None of those decisions are contained in this compilation.
• Because the SOP revokes a prior SOP (s 4), claims that were assessed previously under the 2009 SOP may have been subject to earlier judicial treatment; such decisions are not recorded in this instrument. Practitioners should search tribunal and court databases for cases that mention the specific SOP number or that apply the relevant SOP framework for substance use disorder.

Advice to readers based on the instrument’s silence on litigation:

• Treat the SOP as the authoritative administrative determinative text for the medical factors; when arguing in tribunals or courts, ground submissions in the SOP’s specific language (for example the DSM-5 criteria in s 7(2), the list of factors in s 9, and the service-relationship requirement in s 10(1)).
• Be cautious about inferring how decision-makers or courts will resolve interpretive tensions in the SOP (for example, the treatment of alcohol use disorder) because the compilation contains no adjudicated interpretations. Argue for the construction you propose and, where possible, support positions with contemporaneous policy documentation or other SOPs that may illustrate consistent approaches.

In summary, there is no litigation history contained in the instrument or its endnotes. Users must consult external judicial and tribunal decisions for how the SOP has been interpreted or applied in contested cases.

The SOP contains a number of textual and structural features that create evidentiary, interpretive and procedural traps if not carefully navigated. The following points are drawn from the instrument’s text and the Schedule and should be treated as concrete issues to address in claims and decision-making.

1. Alcohol use disorder exclusion versus list inclusion

   • s 7(2) expressly states the definition of substance use disorder “excludes alcohol use disorder and acute substance intoxication in the absence of substance use disorder.” Yet the Schedule (clinically significant disorder of mental health as specified) explicitly lists “alcohol use disorder” as one of the conditions. This means alcohol use disorder can be a clinically significant disorder for the purposes of ss 9(1) and 9(10), but alcohol use disorder is not to be conflated with “substance use disorder” as defined in s 7(2). Practitioners must disaggregate these concepts exactly as the text does; failure to do so will lead to flawed causation arguments.

2. DSM-5 adoption and medical thresholds

   • The SOP imports DSM-5 criteria verbatim (s 7(2)) and requires four criteria in a 12-month period. The SOP also lists K (tolerance) and withdrawal criteria with notes that they are not met if substances are taken solely under appropriate medical supervision. Medical reports must explicitly apply the DSM-5 thresholds as quoted in the SOP and note whether tolerance/withdrawal criteria are excluded by supervised medical use. Vague clinical language about “dependence” without direct mapping to the listed criteria risks failing to establish the diagnostic threshold.

3. Timing labels: “clinical onset” and “clinical worsening”

   • The sop distinguishes between “clinical onset” and “clinical worsening” and applies mirror factors with different temporal constraints (s 9(1)-(9) for onset; s 9(10)-(17) for worsening). Accurate medical chronology is therefore critical: reports must state precise dates or date ranges for onset and for any worsening event and tie stressors to those dates within the statutory windows (five years for category 1A/1B stressors and death of significant other; one year for category 2 stressors).

4. Temporal windows and relation to service

   • Many factors have strict relative-time windows. For example, a category 1B stressor must be experienced within five years before clinical onset (s 9(3)). Even if a stressor occurred in service, if it falls outside the specified window it will not meet the minimal factor test. Practitioners must check service records for exact dates.

5. Definition of “corpse,” “eyewitness,” and exclusions

   • Schedule 1’s definition of “corpse” excludes seeing a closed body bag or viewing a body in a closed-casket coffin. “Eyewitness” excludes exposure only via mass media or public broadcasting. These narrow definitions mean that some commonly claimed traumatic exposures (for example, seeing media coverage of deaths) will not qualify as category 1B stressors under s 9(3) if they are only media exposures.

6. Substance list breadth

   • “Substance” in Schedule 1 includes tobacco and a broad range of illicit and prescription drug classes. This will capture dependence on nicotine and prescribed opioids or benzodiazepines, but the instrument’s K and withdrawal notes exempt tolerance/withdrawal where substances are taken solely under appropriate medical supervision. Therefore, claims based on tolerance/withdrawal from appropriately supervised prescription regimens may not meet those specific DSM-5 criteria.

7. “Inability to obtain appropriate clinical management” (s 9(18))

   • This is a potentially powerful but evidentially challenging factor. The SOP does not define “appropriate clinical management” or set out how inability is to be proven. Claimants must document attempts to access care, waiting lists, referrals refused, or other concrete barriers. The SOP supplies no procedural form of proof; establishing this factor will be fact-specific and may place evidentiary burdens on claimants.

8. Pre-existing disorder constraints (s 10(2))

   • Factors 9(10)-(18) apply only where the substance use disorder was suffered or contracted before or during but did not arise out of service. That is a nuanced legal condition: these factors are designed to capture material contribution or aggravation, not original causation arising from service. Practitioners must be careful to classify the disorder’s temporal relationship to service correctly.

9. “Clinically significant disorder” does not require actual management

   • Note 2 to the Schedule says that to “warrant ongoing management” does not require that any actual management was received or given. This reduces the evidentiary threshold for proving the existence of a clinically significant disorder in some cases, because absence of evidence of treatment does not preclude the condition being recognised as warranting management.

10. Revocation and amendment navigation

• The SOP revokes the 2009 SOP (s 4) and was itself amended in 2018 (endnotes). Practitioners must ensure they use the version in force at the relevant decision date, and check for any uncommenced amendments or transitional provisions not shown in the compilation.

Failure to address these specific textual points, or to produce the particular types of evidence the SOP requires, will materially weaken a claimant’s ability to raise the reasonable hypothesis the instrument prescribes.

For claimants, medical practitioners, legal advisers and decision-makers dealing with claims under the VEA or MRCA that engage substance use disorder, compliance means producing and assessing evidence against the precise criteria and factors enumerated in this SOP. The following is a practical checklist tied to the instrument’s provisions.

1. Establish the diagnosis using the SOP’s DSM-5 text (s 7(2))

   • Medical reports must state whether the DSM-5 criteria reproduced in s 7(2) are met, identifying which of the ten numbered criteria (1-10) and K are present, and whether they occurred within a 12-month period. If tolerance or withdrawal is relied upon, the expert must state whether the substance was taken under appropriate medical supervision and therefore whether the SOP’s notes exclude those criteria.

2. Pinpoint clinical onset and clinical worsening dates

   • For application of s 9 factors, the claimant must establish the date of clinical onset and the date(s) of clinical worsening. Experts should provide reasoned opinions based on records and history, and state the clinically significant threshold that marks onset or worsening. The temporal linkage to stressors is critical because many factors require timing within five years or one year of onset/worsening (s 9).

3. Demonstrate at least one s 9 factor and its relation to service

   • Systematically check the s 9 list and gather documentary evidence for the relevant factor(s):
     • Clinically significant disorder of mental health: provide psychiatric diagnoses, evidence warranting ongoing management, and note the SOP’s Schedule 1 list (clinically significant disorders) (s 9(1), Schedule 1).
     • Category 1A/1B/2 stressors: gather service records, incident reports, witness statements, and medico-legal evidence to show the occurrence of stressor events within the specified windows (s 9(2), (3), (8), (11), (12), (16); Schedule 1 definitions of stressors).
     • Death of a significant other: provide death certificates, relationship evidence, and link to onset/worsening within five years (s 9(4), Schedule 1 significant other).
     • Medically prescribed substance: show prescriptions, dosing, dates, and pharmacological class mapping to the substances list in Schedule 1 (s 9(5); Schedule 1 substance).
     • Severe childhood abuse: collect child welfare, police or other contemporaneous records and clinical histories consistent with Schedule 1 definition (s 9(6); Schedule 1 severe childhood abuse).
     • Medical illness or injury and persistent pain: obtain clinical records confirming life-threatening illness or persistent pain that meets the Schedule 1 persistent pain definition (s 9(7), (9); Schedule 1 persistent pain).
     • Inability to obtain clinical management: document attempts to access care (referrals, waitlists, correspondence), community treatment capacity issues, or other systemic access failures (s 9(18)).

4. Link every factor to “relevant service”

   • s 10(1) requires that the factor relied upon be related to the relevant service. For stressors occurring during service, link records of the event to the service record type defined in Schedule 1 (operational, peacekeeping, hazardous, British nuclear test defence, warlike, non-warlike). Provide contemporaneous incident reports, service medical records, unit logs, or witness affidavits.

5. Address pre-existing disorders appropriately (s 10(2))

   • If the substance use disorder predates or coincides with service, and did not arise out of service, focus on s 9(10)-(18) factors and show material contribution or aggravation. State clearly whether the claim is for causation arising from service or for aggravation/material contribution where the condition pre-existed.

6. Use the Schedule definitions exactly

   • Ensure that the factual matrix fits the Schedule’s meanings: e.g., “eyewitness” excludes media exposure; “corpse” excludes closed body bag or viewing a body in a closed-casket coffin. Evidence must show first-hand exposure if relying on eyewitness-type stressors (Schedule 1 eyewitness, corpse).

7. Prepare medico-legal reports to the SOP’s structure

   • Experts should produce reports that:
     • explictly reference s 7(2) DSM-5 criteria and identify which criteria are met;
     • provide clear dates for onset and worsening and explain the reasoning behind those dates;
     • match clinical findings to s 9 factors and Schedule 1 definitions;
     • conclude whether the SOP’s minimal factor test is met and whether there is a reasonable hypothesis of a service connection, including how the factor is related to service per s 10(1).

8. Check cross-SOP implications (s 11)

   • If any s 9 factor refers to an injury or disease that is covered by another SOP, identify that SOP and apply its factors in accordance with s 11. For example, if a s 9 factor depends on PTSD diagnosis, and a PTSD SOP exists, apply that SOP’s factors as required.

9. Record-keeping and evidence collection

   • Collect service records, medical and mental health records, pharmacy/prescription data, child protection records, police reports, witness statements, and any documentation of attempts to obtain treatment. Ensure records address both the factual event and the timing relative to clinical onset/worsening.

10. Version control and amendment awareness

• Use the SOP version in force at the decision date. Be aware that this SOP revoked a prior SOP (s 4) and was amended in 2018; check the Legislation Register for further or uncommenced amendments and any application, saving or transitional provisions not included in the compilation.

Following these concrete steps will align claim preparation and medico-legal evidence with the instrument’s specific textual requirements. The task is primarily one of mapping clinical facts and documentary evidence onto the SOP’s enumerated criteria and of demonstrating the necessary temporal and service-related links mandated by s 9 and s 10.