Statement of Principles concerning sudden unexplained death (Balance of Probabilities) (No. 46 of 2022)

The SoP rests on a small number of normative and technical concepts that govern how a finding of connection for sudden unexplained death is to be made. The leading definitional anchor is the statutory meaning of “sudden unexplained death” in subsection 7(2). That provision breaks into three elements: absence of evidence of disease or injury that would account for death; onset-to-death timing within 24 hours; and express inclusion of deaths where life support extended death beyond 24 hours (s 7(2)(a)-(b)). The instrument expressly recognises that, while sudden unexplained death is coded R96 in ICD‑10‑AM, the SoP’s statutory definition controls (s 7(3)-(4)).

The evidential test the SoP supplies is framed as a list of factors, any one of which, if present and related to relevant service, suffices on the balance of probabilities to connect the death to service (s 9; see s 8 for the standard “more probable than not” view). The list includes acute, time-limited exposures or events and chronic or pre-existing medical conditions. Time windows are a recurring device: many acute factors have to occur within 24 hours of death (major stressful event, intense physical activity, cocaine use, blow to the chest), while a specified pharmacological exposure window is seven days (taking a drug that prolongs the corrected QT interval) (s 9(1)-(3), (9)). Numeric thresholds are also used: BMI of 35 or greater (s 9(4)), blood alcohol content (BAC) of at least 0.15 per cent (s 9(8)), and the intensity cut-off for physical exertion at 5 METs (s 9(2) and Schedule 1).

The SoP includes both non-specific, descriptive factors (for example, “experiencing a major, stressful event that causes an intense emotional or psychological response” within 24 hours; s 9(1)) and medically specific diagnostic states (diabetes mellitus, epilepsy, hypertension; s 9(5)-(7)). For pharmacological contributors, the instrument refers to the clinical effect “prolongs the corrected QT interval” rather than listing a closed set of drugs (s 9(9)), and provides non-exhaustive examples of drug classes that can have that effect in a Note to s 9. The SoP likewise includes a note that “many drugs can prolong the corrected QT interval” and examples of drug classes, but does not provide an exhaustive schedule (s 9 Note).

The Schedule 1 definitions operationalise key terms. “Blow to the chest” is defined as a blunt, forceful, non-penetrating impact to the anterior chest, with examples such as assault, gunshot impact while wearing body armour, and certain contact sports (Schedule 1). “MET” is quantified: 1 MET = 3.5 ml O2/kg/min (Schedule 1). BMI is defined as weight divided by height squared, with units specified (Schedule 1). “Relevant service” is itself defined to encompass certain categories of service under the VEA and MRCA, listed expressly in Schedule 1.

Two procedural relationship rules control application. Section 10 requires that any factor in section 9 that is present in the person must be related to the person’s relevant service. Section 11 provides that if a factor in section 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.” Thus the instrument both stands alone for some factors and cross-links into the broader body of SoPs the Authority maintains.

Finally, the instrument states the Authority’s evidentiary posture in s 8: on the sound medical‑scientific evidence available, the Authority is “of the view that it is more probable than not that sudden unexplained death can be related to relevant service” under the VEA and MRCA. That is a declaratory finding about the medical-scientific basis for including sudden unexplained death as a condition for which SoP criteria may establish connection on the balance of probabilities.

The instrument is drafted to affect actors in three interlocking groups: (1) claimants and deceased persons whose cases fall under the statutory hooks in s 5; (2) medical assessors, decision-makers and tribunals that apply SoPs in adjudicating entitlement where a claim is made under the referenced statutory provisions; and (3) the Repatriation Medical Authority itself as the authorising body and repository of the SoP.

Primary subjects: the instrument “applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies” (s 5). The text therefore targets claims brought under those statutory provisions. The instrument does not itself define claimants’ entitlements; rather it supplies the medical-evidentiary criteria that decision-makers must apply when determining whether sudden unexplained death is connected to relevant service on the balance of probabilities (s 9 and s 8). The persons who pay the compliance or evidentiary costs are claimants (and estate representatives) who wish to rely on sudden unexplained death as connected to service; they must marshal the factual materials that satisfy a listed factor and, crucially, its relationship to relevant service (s 10).

Decision-makers and medical assessors are materially affected. The SoP prescribes which factors, and which thresholds and time windows, are sufficient on balance to establish connection. Adjudicators assessing claims under the statutory hooks must consult the SoP for sudden unexplained death where relevant, and where a listed factor is present and related to relevant service they are provided with an evidentiary basis to find connection on the balance of probabilities (s 9, s 10, s 11). The instrument’s cross-references (s 11) mean assessors must also check whether any factor points to another SoP, in which case that other SoP applies “as in force from time to time” (s 11(2)). The Authority’s statement of the medical-scientific basis (s 8) supplies the evidentiary foundation for the SoP’s inclusion in the adjudicative toolkit.

The Repatriation Medical Authority is both author and subject because it determines SoPs under s 196B(3) of the VEA, and this instrument records the exercise of that power (s 3). The instrument notes the Authority’s seal was affixed at the direction of its Chairperson; that records formal adoption (instrument front material). The Authority will continue to be responsible for issuing, maintaining and updating SoPs, including cross-referencing to other SoPs where applicable (s 11).

Others indirectly affected include coronial offices, pathologists and treating clinicians who produce records (autopsy, toxicology, clinical notes) that will be used to establish a factor listed in s 9, and anyone who supplies service records needed to show the factor is related to relevant service (s 10). However, the instrument itself does not place direct duties on clinicians or coronial bodies; it prescribes the evidential form decision-makers will apply.

The instrument also alters the legal landscape for any party contesting a claim: the SoP defines specific thresholds and time windows that will be focal points of evidentiary dispute (for example, the 24‑hour window, BMI ≥ 35, BAC ≥ 0.15 per cent, 5 METs intensity). Parties will need to address those precise thresholds when building or opposing causation arguments.

This Statement of Principles does not, on its face, create statutory duties enforceable by penalties; rather it establishes medical-evidentiary criteria that must be applied when determining connection for claims falling within the specified statutory hooks. The operative duties and rights flow from how decision-makers and claimants are required to use the SoP in claims processes under the VEA and MRCA, as captured in s 5, s 9, s 10 and s 11.

Duty to apply the SoP in relevant claims: The instrument “applies to a claim” under the specified sections (s 5). That means decision-makers assessing such a claim are required, as part of the adjudicative process under the enabling statutes, to consider the SoP when sudden unexplained death is at issue. The SoP supplies the criteria that must be checked: at least one of the section 9 factors must be present before it can be said, on the balance of probabilities, that sudden unexplained death is connected with circumstances of relevant service (s 9).

Duty to establish relationship to relevant service: Section 10 requires that the existence in a person of any factor referred to in s 9 “must be related to the relevant service rendered by the person.” That places on claimants the task of adducing, and on decision-makers the duty to evaluate, evidence linking the present factor to the person’s relevant service. The instrument does not set out the form or standard of proof for that relationship beyond the general balance-of-probabilities framing for connection, but s 10 makes the nexus to service a threshold requirement.

Duty to observe cross-SoP rules: Where a factor in s 9 “refers to an injury or disease in respect of which a Statement of Principles has been determined” under the VEA, section 11 provides that the factors in that other SoP apply “in accordance with the terms of that Statement of Principles as in force from time to time.” Practically, this imposes on decision-makers a duty to check the SoP ecosystem for other, potentially authoritative SoPs that might govern a particular factor, and to apply those terms rather than the instant instrument in isolation.

Rights and evidentiary effects: For claimants, the SoP creates an evidentiary right in the sense that the presence of any listed factor, if related to relevant service, establishes connection on the balance of probabilities. Section 8 records the Authority’s view “that it is more probable than not” that sudden unexplained death can be related to relevant service; that statement is intended to underpin the evidentiary utility of the SoP for claimants. Where a factor is proven and linked to service, decision-makers have a statutory basis to find causation without requiring additional medical opinion that goes beyond the SoP framework (subject to the enabling statute’s rules and any other applicable SoPs).

No criminal or civil penalties provided: The instrument contains no provisions that create penalties, fines or criminal offences. It operates as a declarative and evidentiary instrument rather than a punitive one. The SoP is a tool used within the statutory administrative claim processes referenced in s 5.

Administrative discretion: The SoP itself sets bright-line factors and thresholds. However, application of those factors necessarily involves administrative judgment about whether the factual material satisfies the criterion (for example, whether a physical exertion bout reached at least 5 METs or whether a drug actually prolonged the corrected QT interval in the individual). The instrument does not prescribe the method of that factual evaluation; it therefore leaves decision-makers with procedural discretion in assessing the quality and sufficiency of evidence that a factor both existed and was service-related (s 9, s 10, s 11).

Documentation and evidentiary production: Implicitly, claimants and their representatives must assemble medical, toxicological and service records sufficient to establish a s 9 factor and its relationship to relevant service. The SoP’s specified numeric thresholds and temporal windows focus evidentiary activity on particular measurements and records (for example, BMI calculation per Schedule 1, blood alcohol measurement at least 0.15 per cent, documented drug exposure within seven days). The instrument does not mandate who must produce these materials but sets the evidential expectations decision-makers will apply.

The Statement of Principles is an evidentiary instrument and does not itself create penalties, enforcement sanctions or criminal liabilities. The text contains no provisions imposing fines, imprisonment, or civil penalties; it prescribes criteria to be applied within claim adjudication processes rather than enforcement mechanisms. That is apparent from the structure and content: the instrument defines a medical condition (s 7), enumerates factors that, if present and service-related, support connection (s 9), and cross-references other SoPs (s 11), but it does not provide for enforcement actions or penal consequences.

Enforcement in practice means administrative decision-making within the statutory claim processes invoked by s 5. The instrument “applies to a claim to which section 120B of the VEA or section 339 of the MRCA applies” (s 5). The SoP therefore functions as a determinative tool used by the relevant administrative decision-makers and potentially by tribunals in reviewing claim determinations. The instrument itself does not identify which administrative body will apply it; it only specifies the statutory claims to which it applies. The mechanics of enforcement and remedies for non-compliance with the SoP will be those provided under the VEA and MRCA and their procedural regimes, which are outside the content of this instrument.

There is an evidentiary enforcement effect rather than a penalty: when a listed factor in s 9 is present and related to relevant service (s 10), that suffices to establish connection on the balance of probabilities. The practical consequence for claim processing is that proof of a qualifying factor can be dispositive of causation questions within the relevant statutory framework. Conversely, absence of any listed factor, or inability to show the factor is related to relevant service, will undermine a claimant’s case that sudden unexplained death is service-connected as per this SoP.

Administrative discretion and review: The instrument does not specify appeals, review paths or internal enforcement processes. Those procedural aspects will be governed by the enabling statutes and their administrative regimes. The SoP’s text does not provide an internal mechanism for enforcing adherence to the SoP by decision-makers; it provides the standards decision-makers must apply. Any failure by an administrative decision-maker to apply the SoP where relevant would be a matter for the statutory review avenues under the VEA or MRCA rather than a penalty under the SoP.

Scope limits on enforcement: The instrument expressly allows that certain factors may be governed by other SoPs (s 11). That allocative rule can affect enforcement because, where another SoP applies, decision-makers must apply the terms of that other SoP “as in force from time to time,” which may broaden, narrow or otherwise alter the evidentiary consequences for specific factors relative to what section 9 alone provides. The SoP does not itself resolve conflicts of terms; it directs decision-makers to apply the other SoP’s content where applicable.

This SoP is designed to be an integrated part of the statutory framework governing veterans’ and members’ claims under the VEA and MRCA. The text explicitly binds itself to that broader legal environment in several ways.

Statutory application hooks: Section 5 states the instrument “applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.” That linkage means the SoP is operationalised only within the context of claims governed by those statutory provisions. The instrument therefore does not create standalone entitlements; its legal effect is realised when decision-makers apply it pursuant to the enabling statutes.

Rule of precedence with other SoPs: Section 11 creates a direct interaction rule: if a factor in s 9 “refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA,” then 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 establishes a hierarchical or coordinating mechanism among SoPs. Practically, a decision-maker encountering a factor in s 9 that is also the subject of another SoP must apply the other SoP’s terms, not substitute the present instrument’s formulations where they differ. The SoP therefore functions as part of an interlocking matrix of medical-evidentiary instruments, and cross-SoP consistency is required by s 11.

Reference to ICD-10-AM: Section 7(3)-(4) notes that sudden unexplained death attracts ICD‑10‑AM code R96, and specifies the version of ICD‑10‑AM (Tenth Edition, effective 1 July 2017) that is being referenced for coding purposes. However, the instrument makes explicit that in applying the SoP the statutory definition in s 7(2) controls. That interaction matters for practitioners who may consult clinical coding resources or pathology reports that reference ICD coding; the SoP clarifies that the instrument’s definition governs the legal test even if a clinical code is cited in medical records.

Definitions interacting with VEA and MRCA: Schedule 1 defines “relevant service” by reference to specific categories under the VEA and MRCA (Schedule 1). The instrument therefore depends on those statutes for the substantive scope of who may claim under this SoP. The SoP does not redefine or expand those statutory categories; it imports them verbatim into the dictionary and relies on the enabling statutes for their substantive meaning and any procedural rules around eligibility.

Operational interaction with claim evidence: The SoP’s thresholds (for example BMI ≥ 35, blood alcohol ≥ 0.15 per cent, drug exposure within 7 days, and the 24‑hour windows) interact with evidentiary and procedural law. For example, coronial and toxicology reports, service records and medical histories are the likely sources of proof; how those records are obtained, disclosed and tested will be governed by the general rules in the enabling statutes and associated administrative procedures, which this instrument does not itself modify.

Repeal and replacement: Section 4 repeals the earlier SoP (No. 58 of 2013). That repeal creates a temporal interaction: for claims decided after the commencement date, the 2022 SoP governs; for claims decided prior to commencement, the 2013 instrument applied. The instrument does not provide transitional provisions; practitioners must therefore rely on the statutory regimes (VEA and MRCA) or administrative practice to determine transitional application in borderline cases. The repeal means that any factor formulations that were present in the 2013 SoP but altered in the 2022 instrument must be applied according to the current instrument for claims to which the current instrument applies (s 4).

Cross-disciplinary interaction: The instrument’s references to pharmacological effects (QT prolongation), metabolic measures (BMI), and exercise physiology (METs) mean the SoP interacts with clinical practice and scientific measurement. Clinical definitions and measurements in medical records will be used as legal evidence under the SoP; courts or tribunals may need to interpret medical measurements against the SoP’s thresholds. The SoP does not provide methodologies for establishing METs or for calculating corrected QT interval in a particular person; those technical questions will engage medical expert evidence and the broader bodies of clinical practice and law.

The instrument itself is concise and contains its immediate amendment history within its text. It is identified as “No. 46 of 2022,” dated 29 April 2022 and commencing 30 May 2022 (front material; s 2). Section 4 explicitly repeals the prior Statement of Principles concerning sudden unexplained death No. 58 of 2013 (Federal Register of Legislation No. F2013L01646), which had been made under the same enabling subsection (s 4). No other amendments or sequential changes are recorded in this instrument.

Relevant cross-references that affect historical reading are:

• The instrument’s dependence on subsection 196B(3) of the Veterans’ Entitlements Act 1986, under which the Repatriation Medical Authority determines Statements of Principles (s 3). The SoP therefore fits into the periodic process by which the Authority issues, replaces and updates SoPs.

• The instrument references ICD‑10‑AM (Tenth Edition, effective 1 July 2017) for coding (s 7(4)). This is a frozen external reference to a particular edition of the clinical classification system. The choice of edition is an explicit textual anchor for how clinical coding references should be read in relation to the SoP. The instrument does not itself amend or alter ICD coding; it merely identifies the edition being referenced for the record.

No subsequent amendments, corrigenda or variations to this instrument are recorded in the text supplied. The instrument states that where a factor in s 9 refers to an injury or disease covered by another SoP, that other SoP applies “as in force from time to time” (s 11). That phrase anticipates that other SoPs may be amended in future and those amendments will affect the operation of this instrument when cross-referenced. The instrument itself contains no mechanism for automatic updating of its own content, beyond the cross-reference that allows other SoPs’ evolving terms to bind in cases where s 9 refers to them.

Practitioners needing a complete amendment history must consult the authoritative register (for example the Federal Register of Legislation or the Repatriation Medical Authority’s published instruments) for any later updates, revocations or consolidations. The instrument’s own text documents only the single repeal of the 2013 Statement and its commencement date in 2022.

This instrument contains no recorded litigation history within the text supplied. It does not cite any cases, judicial interpretations, tribunal decisions or litigation outcomes. The text confines itself to the Repatriation Medical Authority’s statutory exercise of power under subsection 196B(3) of the VEA and does not report or summarise any judicial scrutiny of prior or current versions of the SoP.

Because the instrument is an administrative evidentiary instrument used within the statutory claim processes of the VEA and MRCA, litigation or tribunal review relating to its application may exist in external sources, but none are recorded in the instrument itself. The instrument does not include a schedule of prior legal challenges to the 2013 SoP or to the Authority’s determinations generally. It also contains no notes about how tribunals or courts have construed the sorts of factors it lists, nor any internal case law citations.

Practitioners requiring a litigation history or precedential guidance on how courts and tribunals interpret the operation of Statements of Principles should consult published decisions under the VEA and MRCA, and any administrative tribunal decisions, for which this instrument does not supply specifics. For the present instrument, the text is silent on prior litigation and contains no judicial gloss; its utility in adjudication will depend on how decision-makers and courts subsequently treat its content in the ordinary course of statutory review and appeals.

This SoP contains several narrow textual features and cross-references that are likely to be focal points in practical application. The following are concrete points of attention drawn directly from the instrument’s wording and Schedule definitions.

Temporal windows are strict and short: several acute factors require occurrence within 24 hours of the sudden unexplained death (s 9(1), (2), (3), (10)). A failure to produce evidence that an event or exposure happened within that 24‑hour window can prevent a factor from qualifying. Similarly, the pharmacological exposure window for drugs that prolong corrected QT interval is seven days (s 9(9)). The SoP does not provide for any flexible interpretation of those windows; decision-makers will apply the listed timings when assessing the presence of a qualifying factor.

Numeric thresholds are exact: BMI must be “35 or greater” (s 9(4) and Schedule 1 gives the BMI formula). Blood alcohol content must be “at least 0.15 per cent” (s 9(8)). Physical exertion requires at least 5 METs (s 9(2) and Schedule 1 for the MET definition). These precise thresholds mean that measurement technique, timing of measurement and recordation of metrics become decisive evidentiary issues. For BMI, the weight and height used must be verifiable; for BAC, timing of sample collection and method matter. The SoP provides the formula for BMI but does not specify when or how BMI should be measured relative to death; practitioners must rely on available medical records.

Scope of “taking a drug that prolongs the corrected QT interval” is broad and open to interpretation: s 9(9) identifies classes of drugs as examples and notes “many drugs can prolong the corrected QT interval.” The instrument provides no closed list or objective, jurisdictionally bounded schedule of QT-prolonging drugs. Establishing that a particular agent taken by a person in the relevant window actually prolonged that person’s QT interval requires clinical or expert evidence. The SoP leaves that factual assessment to decision-makers.

Requirement that factors be related to relevant service (s 10): The SoP does not say that the mere presence of a factor is sufficient; s 10 requires that the factor be related to the person’s relevant service. Proving that relationship may involve showing a causal link between service exposures or events and the factor at death (for example, that a stressful event linked to service precipitated the acute response in s 9(1)). The instrument does not define how “related” must be construed,this will be an evidentiary and legal question in each case.

Cross-SoP referral can alter the applicable tests (s 11): If a factor “refers to an injury or disease” governed by another SoP, the other SoP’s terms apply. That can change thresholds, time periods or the evaluative approach. Practitioners must check the SoP register for other relevant SoPs; failure to do so may lead to misapplication.

Definition of “sudden unexplained death” excludes deaths where disease or injury can be established as the cause: s 7(2)(a) limits the concept to deaths “without evidence of disease or injury which could account for the death.” If post-mortem or clinical evidence establishes a cause, the SoP will not apply. Practitioners should note that a final death certificate stating cause unknown is the norm in such cases (s 7 Note), but the instrument’s statutory definition is outcome-dependent.

Inclusion of deaths prolonged by life support: The instrument explicitly includes deaths “delayed beyond 24 hours because of life support by mechanical devices” (s 7(2)(b)). That means that the 24-hour timing rule in s 7(2)(a) is not an absolute bar where life support extended death; evidence about life support and timing will be necessary.

Ambiguity in “major, stressful event” and “intense emotional or psychological response” (s 9(1)): The instrument gives examples (direct threat to life, assault including sexual assault) but does not offer an exhaustive list or an objective scale for “intense” response. This leaves room for contested interpretation and necessity for medical or psychological expert evidence.

Examples versus exhaustive lists: The SoP includes Notes that give examples (for blow to the chest, QT-prolonging drug classes, and stressful events). The Notes are explanatory and not exhaustive. Practitioners should not treat examples as limiting; however, they must be cautious in relying on them as definitive guides.

ICD coding reference is ancillary: Section 7(3) notes that sudden unexplained death attracts ICD‑10‑AM code R96 but clarifies that the statutory definition in s 7(2) controls. Reliance solely on ICD coding in medical records without addressing the statutory elements in s 7(2) could mislead a decision-maker.

No procedural instructions or evidentiary burden specification: The SoP sets substantive factors and thresholds but does not specify procedural mechanisms for establishing them, who bears the precise evidentiary burden of proof in the claim processes, or how to resolve conflicting expert opinions. Those procedural matters are governed by the enabling statutes and administrative practice outside the instrument’s text.

Relevance of service categories: The instrument defines “relevant service” in Schedule 1 in specific terms tied to the VEA and MRCA. Whether a particular episode of service qualifies is determined under those statutes; the SoP does not alter eligibility definitions.

Compliance with this Statement of Principles is primarily evidentiary and procedural: claimants (and those acting for estates), medical assessors, and decision-makers must present and evaluate the specific types of evidence the instrument identifies. The following is a practical checklist, tied to the instrument’s text, for assembling and assessing a sudden unexplained death claim under this SoP.

1. Confirm statutory applicability (s 5)

• Establish that the claim falls within a claim to which s 120B of the VEA or s 339 of the MRCA applies before treating this SoP as operative. The SoP only “applies to a claim” under those sections (s 5), so a threshold eligibility check against the relevant statutes is required.

2. Determine if the death meets the SoP definition (s 7)

• Verify that the death is one “without evidence of disease or injury which could account for the death” and occurred within 24 hours of first onset of symptoms or signs, or was delayed beyond 24 hours due to mechanical life support (s 7(2)). A final death certificate stating that cause cannot be determined is consistent with the SoP note. Gather coronial findings, autopsy reports and death certificates as primary evidence.

3. Check for at least one qualifying factor (s 9)

• Systematically test each of the ten factors in s 9 against the available records:
  • Major stressful event causing an intense emotional or psychological response within 24 hours (s 9(1)): assemble incident reports, witness statements, contemporaneous records, clinical notes, or police reports. Where possible, obtain expert psychiatric or psychological opinion linking the event to an acute response.
  • Intense physical activity ≥ 5 METs within 24 hours (s 9(2)): document activity type, duration and intensity; if uncertain, obtain an exercise physiologist or medical expert to assess whether the activity reached ≥ 5 METs, using the Schedule 1 MET definition.
  • Blow to the chest immediately before death (s 9(3) and Schedule 1): collect witness accounts, medical imaging, bruising/trauma records, scene reports; ensure the impact was blunt, forceful, non‑penetrating and to the anterior chest per Schedule 1.
  • BMI ≥ 35 at time of death (s 9(4) & Schedule 1): secure reliable weight and height records near the time of death for BMI calculation using the provided formula.
  • Diabetes mellitus, epilepsy, hypertension at time of death (s 9(5)-(7)): obtain medical history, treatment records, prescriptions and specialist letters confirming diagnoses.
  • Blood alcohol content ≥ 0.15% at time of death (s 9(8)): obtain toxicology reports with precise BAC measurements and specimen collection timings.
  • Taking a drug that prolongs corrected QT interval within 7 days (s 9(9)): produce prescription records, medication administration records, toxicology reports and clinical notes indicating drugs taken in the seven days prior to death; where relevant, obtain ECG records or expert cardiology evidence on QT interval.
  • Taking cocaine within 24 hours (s 9(10)): rely on toxicology reports with time-of-use estimates where possible, and consider metabolite levels interpreted by toxicology experts.

4. Prove relationship to relevant service (s 10)

• For any factor that is present, assemble evidence linking that factor to the person’s relevant service (as defined in Schedule 1). This may require:
  • Service records demonstrating the timing and nature of service-related events or exposures.
  • Medical records that show the onset of the factor is temporally and causally connected to service activities.
  • Expert opinion tying the service exposure or event to the subsequent factor (for example, that a service‑related assault led to the “major stressful event” in s 9(1)).
• The SoP requires that any factor “must be related to the relevant service rendered by the person” (s 10). Mere presence of a factor without any service nexus will not suffice.

5. Check for cross-SoP coverage (s 11)

• If a factor in s 9 refers to an injury or disease that is the subject of another SoP, apply the other SoP’s factors “as in force from time to time” (s 11). Determine whether conditions such as diabetes, epilepsy or hypertension are governed by separate SoPs and, if so, follow those instruments’ terms.

6. Gather forensic and medico-legal evidence

• Coroner’s examinations, autopsy findings, histology, toxicology and ECGs are likely to be central. Where the SoP hinges on measurement (BMI, BAC, METs), ensure chain of custody, sample timing, measurement technique and expert interpretation are documented.

7. Expert evidence and interpretation

• The SoP provides thresholds but does not prescribe how to adjudicate disputed clinical interpretations (for example, whether an activity reached 5 METs, or whether a drug actually prolonged a specific person’s corrected QT interval). Prepare to call appropriate clinical experts (cardiology, toxicology, psychiatry, exercise physiology) to interpret the raw data against the SoP’s criteria.

8. Document timing carefully

• The SoP uses tight windows. Precisely document the timing of symptom onset, the timing of events, the timing of toxicology sampling and the timing of any life-support interventions, because temporal proofs determine whether a factor falls within the stipulated window (s 7(2), s 9).

9. Be alert to measurement and definition pitfalls

• For BMI, use the formula provided in Schedule 1 and verify that the height and weight used are contemporaneous and reliable.
• For METs, use accepted clinical conversions and expert assessment to demonstrate intensity.
• For QT-prolonging drugs, do not rely solely on class examples in the Note; document the specific agent and establish its effect in the individual within the seven‑day window.

10. Prepare for cross-claim procedural issues

• Since the SoP applies only to claims under specified statutory sections (s 5), ensure pleadings, claim forms and submissions accurately identify the legal basis for the claim to ensure the SoP is applied.

11. Consider alternative causes

• The SoP applies only where death is “without evidence of disease or injury which could account for the death” (s 7(2)(a)). If post-mortem evidence establishes an alternative cause, the SoP will not apply. Be prepared to address competing medical explanations in submissions.

12. Update and check other SoPs

• Before finalising a submission, check the current list of SoPs (as s 11 contemplates SoPs “as in force from time to time”) to ensure no relevant SoP has been updated that affects interpretation of a factor.

By following this evidence-focused compliance approach, claimants and advisers can align documentary and expert proof with the precise thresholds, temporal rules and definitional anchors established in this SoP. The SoP supplies substantive criteria (s 7, s 9) and a service-relatedness requirement (s 10); compliance therefore turns on proving both that a qualifying factor existed as specified and that it was related to the person’s relevant service.