Statement of Principles concerning thoracolumbar spondylosis (Reasonable Hypothesis) (No. 13 of 2023)

The instrument rests on three core concepts: the definitional scope of the disease (what counts as thoracolumbar spondylosis), the RMA "reasonable hypothesis" methodology (factors that, if present, suffice to connect disease to service), and the temporal/causal relationship rules tying those factors to relevant service.

Definition and diagnosis. Thoracolumbar spondylosis is defined clinically and anatomically (s 7(3)): a degenerative joint disorder of thoracolumbar vertebrae or intervertebral discs, including junctional spondylosis. Diagnosis requires both clinical manifestations , local pain and stiffness or thoracolumbar cord or nerve root compression , and imaging evidence of degenerative change (s 7(2)(a)-(b)). The Schedule’s imaging definition clarifies that imaging typically post-dates clinical onset and includes modalities such as X-ray or MRI. The SOP expressly excludes certain conditions from the definition: diffuse idiopathic skeletal hyperostosis, Scheuermann disease, and simple disc bulging without other degenerative signs (s 7(4)). The instrument assigns specific ICD-10-AM codes for consistency (s 7(6)-(8)).

Reasonable hypothesis via listed factors. The RMA approach here is mechanical: the presence of at least one enumerated factor (s 9) is the minimum to raise the reasonable hypothesis that the condition or death is related to relevant service. The list is heterogeneous: it ranges from high-exposure occupational metrics (lifting a cumulative 100,000 kg of ≥20 kg loads in any 10-year period, s 9(13)) and duration-based carrying exposures (3,800 hours, s 9(14)), to specific clinical antecedents (intra-articular spinal fracture ≥6 months prior, s 9(4); thoracolumbar intervertebral disc prolapse ≥6 months prior, s 9(12)), to constitutional or systemic contributors (obesity for ≥10 years, s 9(16); acromegaly, s 9(17); Paget’s disease, s 9(18)). Some factors apply only to lumbar spondylosis (kyphotic/lordotic abnormalities, leg length inequality, and operational aircrew hours; see s 9(6), (8), (15), (24), (26), (33)). Traumatic factors have timing limits: spinal trauma must be at least 6 months before clinical onset and, when claimed, the trauma must have occurred within 20 years before clinical onset (s 9(10) and Schedule 1 definition of trauma).

Temporal and causal connection rules. Section 10 requires the factors to be "related to the relevant service" (s 10(1)). For subsections 9(19) to 9(37), which concern material contribution or aggravation, they apply only where thoracolumbar spondylosis was suffered or contracted before or during, but did not arise out of, relevant service (s 10(2)). This create a categorical distinction between factors used to establish causation for new onset versus those used to establish contribution/aggravation of pre-existing disease.

Interaction with other SOPs and medical categories. Section 11 instructs that if a factor refers to an injury or disease for which another SOP exists, the factors of that other SOP apply as that SOP is in force. The Schedule lists specific diseases and conditions (e.g. depositional and inflammatory joint disease lists, specified spinal conditions), which creates a network of potential cross-references: e.g. ankylosing spondylitis or gout are separately specified and will be assessed according to their own SOPs where applicable.

Evidence definitions that matter in practice. The Schedule defines clinical onset (the point back from the first date of imaging confirming disease to when symptoms were persistently present, as assessed by a registered medical practitioner), imaging evidence, BMI, leg length inequality (≥2 cm clinically significant disparity uncorrected), penetrating injury, spinal fusion, and trauma (which requires discrete event, onset within 24 hours, persistence for at least 7 days unless specific interventions occurred) , each of these definitions fixes evidentiary thresholds and time windows (Schedule 1).

ICD coding and death attribution. The SOP assigns ICD-10-AM codes and expressly includes death from thoracolumbar spondylosis if the disease contributed to death via a terminal event as defined (s 7(6)-(9) and Schedule: terminal event list). This allows the RMA to link disease and mortality through contributory causation where the disease is not necessarily the proximate cause of death.

Collectively, the main concepts create a rule-based framework: a diagnosed condition requires clinical and imaging evidence; presence of at least one enumerated factor linked to relevant service satisfies the RMA’s "reasonable hypothesis"; temporal rules determine whether the factor establishes causation for onset or material contribution/aggravation; cross-references to other SOPs apply; and defined evidentiary thresholds govern burden of proof.

Directly affected persons. The instrument applies to claimants who bring claims under section 120A of the VEA or section 338 of the MRCA (s 5). That includes veterans and eligible members of the Forces whose claims involve thoracolumbar spondylosis or death from it. The Schedule defines "relevant service" expansively to include operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, and warlike or non-warlike service under the MRCA (Schedule 1: relevant service). Thus a broad class of current and former service personnel who rendered one of those forms of service are within scope.

Medical professionals and decision-makers. Registered medical practitioners and RMA-assigned assessors are affected functionally because the SOP requires clinical assessments (clinical onset assessed by a registered medical practitioner, Schedule 1) and imaging corroboration (s 7(2)(b) and Schedule). The instrument prescribes clinical definitions that clinicians must apply when preparing opinions to establish diagnosis, onset, and the presence of specified factors. Administrators within the Department of Veterans' Affairs and delegates making entitlements decisions will use the SOP as the statutory framework to determine whether the RMA’s threshold for a reasonable hypothesis is met.

Service record custodians and employers. The SOP’s reliance on service records and occupational exposure evidence (for example POW status, aircrew hours, lifting/carrying exposure) implicates Defence and related record-keepers because claims will require verification from service logs, operational records, and occupational histories. Employer or unit records that document exposure to heavy lifting or hours in affected roles will be relevant, particularly where cumulative thresholds are required (s 9(13)-(15), (31)-(33)).

Third-party medical specialists and allied health. Where factors require specialist diagnoses , for example inflammatory joint diseases (ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, Schedule list) or depositional joint diseases (gout, haemochromatosis, etc.) , the opinions of rheumatologists, orthopaedic surgeons, radiologists, and endocrinologists (acromegaly, Paget’s) will be material. Surgical records evidencing spinal fusion or intra-articular fractures also influence outcomes (s 9(4), (7), Schedule definitions).

Those indirectly affected. Family members and estate administrators in claims for death from thoracolumbar spondylosis are affected because the SOP includes death where a terminal event is contributed to by the condition (s 7(9)). The terminal event list (Schedule) includes causes often recorded on death certificates (pneumonia, respiratory failure, cardiac arrest), which may be used to link a claimant’s death to antecedent spinal disease. Legal representatives, such as solicitors, will need to secure medical and service records to establish the nexus.

Excluded or limited groups. The SOP excludes certain diagnostic entities from the definition of thoracolumbar spondylosis (s 7(4)): diffuse idiopathic skeletal hyperostosis, Scheuermann disease and isolated disc bulging without other degenerative signs. Persons whose spinal condition is exclusively one of those excluded categories are not covered by this SOP. Also, some factors apply only to lumbar spondylosis rather than thoracic or thoracolumbar generally (see s 9 notes on lumbar-only items). Finally, where a factor refers to a condition covered by another SOP the other SOP applies (s 11), potentially shifting evidentiary or factor requirements.

Scale and burden implications. Practitioners advising affected persons should anticipate that claims will demand documentary medical and service evidence to establish clinical onset, imaging confirmation, and the presence and timing of any enumerated factor tied to service. Many factors require long look-back periods (for example obesity for 10 years, cumulative occupational exposures over 10 or 25 years), so historical records and longitudinal medical data will be relevant.

Duties of the decision-making framework. The SOP imposes duties on RMA assessors and decision-makers to apply its definitions and factors when considering whether a reasonable hypothesis connects thoracolumbar spondylosis (or death from it) to relevant service. The instrument itself is declaratory and prescriptive as to the medical factors: decision-makers must determine whether the claimant has a diagnosis that meets the clinical and imaging tests (s 7(2)), and whether at least one of the section 9 factors exists and is related to the person’s relevant service (s 9; s 10(1)). For material contribution or aggravation, assessors must check the pre-existence criteria in s 10(2) before applying factors in subsections 9(19)-9(37).

Duty to consider cross-referenced SOPs. Where a factor refers to an injury or disease covered by another SOP, decision-makers have a duty to apply that other SOP's factors as they are in force (s 11). That means the assessor must identify cross-references in the Schedule lists (e.g. inflammatory joint diseases, depositional joint diseases, specified spinal conditions) and apply the relevant SOP criteria where necessary.

Duties on medical practitioners providing evidence. The Schedule makes the clinical onset determination contingent on assessment by a registered medical practitioner (Schedule, definition of clinical onset). Practitioners providing evidence must therefore state dates of first persistent symptoms and their judgment about when clinical onset occurred relative to imaging confirmation. Surgeons and treating clinicians must document interventions (spinal fusion, injections, immobilisation) in order for trauma or surgery-related factors to satisfy Schedule criteria.

Rights of claimants. Claimants have the right to have their condition assessed under this SOP where they bring a claim under s 120A VEA or s 338 MRCA (s 5). If a claimant can demonstrate a diagnosis per s 7 and one or more factors listed in s 9 that are linked to relevant service per s 10, the RMA methodology will regard the reasonable hypothesis as raised, which has evidentiary consequence in the veteran entitlements decision-making process under the VEA/MRCA framework. The SOP also specifies ICD codes (s 7(6)-(8)), so claimants can align diagnostic coding evidence to those codes.

Evidentiary burdens and rights to supporting records. The SOP’s definitions create specific evidentiary thresholds: documented imaging showing degenerative change (Schedule), medical notes establishing persistent symptoms, service records for POW status, aircrew hours, or documented trauma, and objective measures for BMI and leg length inequality (Schedule definitions). Claimants have the practical right to obtain and submit these records; decision-makers are bound to assess the claim against the SOP’s defined criteria.

Limits on duties and rights. The SOP is a medical threshold instrument; it does not itself determine entitlements or compensation. It is an evidentiary tool within the statutory scheme under the VEA and MRCA. The instrument does not create a positive duty on third parties to produce records; practical access to historical service records and long-term medical records may be constrained, which affects the claimant’s ability to exercise their rights. Also, the SOP’s exclusion clauses (s 7(4)) and the cross-reference rules (s 11) mean rights to a finding under this SOP can be displaced where other SOPs or exclusions apply.

Operational discretion and standard of proof. The SOP specifies the RMA’s threshold of "reasonable hypothesis" by listing qualifying factors (s 9). The instrument does not itself articulate the administrative standard of proof for final entitlement decisions under the VEA/MRCA, but the SOP creates the evidentiary framework that decision-makers must apply when considering whether the RMA’s threshold assists a claimant in meeting the relevant legal tests for service connection.

Nature of instrument: administrative, not penal. The Statement of Principles is an administrative instrument that sets medical criteria for the linkage between thoracolumbar spondylosis (and death from it) and relevant service (s 3; s 5). It does not create criminal offences, civil penalties, or an enforcement regime within its text. There are no penalty provisions or enforcement mechanisms described in the instrument itself.

Enforcement through entitlement decisions. The practical enforcement effect of the SOP is indirect: the RMA’s determinations inform claims assessment under the VEA and MRCA. That is, the SOP supplies the medical criteria that decision-makers, such as delegates of the Department of Veterans' Affairs, will use when assessing whether a claimant has satisfied the medical nexus requirements for entitlement. The instrument itself does not specify sanctions or penalties for non-compliance; its "enforcement" is through administrative application, which can change the legal outcome of a claim for benefits, rehabilitation or compensation under the VEA/MRCA framework.

Consequences for misrepresentation. While the SOP does not set penalties, supply of false or misleading evidence in a claim may implicate other statutory provisions in the VEA or MRCA or general Commonwealth laws governing fraudulent claims; however, this instrument does not reference or establish those. Any action alleging misrepresentation or fraud would be authorised or penalised only by the provisions of the VEA, MRCA or other statutes expressly providing for such penalties, not by this SOP itself.

No inspection or compliance powers stated. The SOP does not grant inspection, testing, or compliance powers to any agency beyond the RMA’s power to make the instrument under subsection 196B(2) of the VEA (s 3). There is no express requirement for third parties to produce records, nor are there coercive powers described in the text.

Remedies and review processes are external. The instrument does not detail administrative review or merits review processes. Remedies for claimants whose claims are refused when judged against this SOP are governed by the appeal and review mechanisms contained in the VEA and MRCA and by general administrative law remedies (judicial review), none of which are described or modified by this SOP. The instrument itself therefore does not change statutory penalties or enforcement; it supplies criteria that feed into those statutory processes.

Practical implication: evidentiary enforcement. The SOP enforces its requirements practically by setting objective thresholds and definitions that create predictable points of proof (e.g. cumulative lifting totals, 10-year obesity duration, 2 cm leg length inequality). Where claimants cannot produce evidence to meet these thresholds, an administrative determination under the VEA/MRCA is likely to find the RMA’s reasonable hypothesis unmet. The SOP therefore operates as an evidentiary gatekeeper rather than a source of direct penalties or enforcement powers.

Primary statutory anchoring. The SOP is made under subsection 196B(2) of the VEA (s 3). It applies to claims under section 120A of the VEA or section 338 of the MRCA (s 5), positioning it within the broader statutory schemes of veteran entitlements and military rehabilitation/compensation. Decisions by RMA to issue SOPs are part of the VEA/MRCA framework: SOPs are medical-evidentiary instruments that the DVA and decision-makers must consider when assessing claims under those Acts.

Cross-references to other Statements of Principles. Section 11 requires that if a factor in this SOP refers to a disease or injury for which a separate SOP exists, then the factors in that other SOP apply in accordance with its terms as in force from time to time. The Schedule enumerates lists , for example the specified list of inflammatory joint diseases and depositional joint diseases, and specified spinal conditions , which will commonly be the subject of other SOPs. Practitioners therefore must identify overlaps and apply the relevant SOP(s) in combination. This creates a networked interaction between SOPs: the presence of ankylosing spondylitis (listed in this SOP) triggers the application of the ankylosing spondylitis SOP.

Interaction with medical classification systems. The instrument expressly references ICD-10-AM codes (s 7(6)-(8)). That ties diagnostic characterisation in claims to that international/Australian-modified classification system as published (The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, Tenth Edition, effective date 1 July 2017). Claim files that use ICD coding will find this alignment affects interpretation of diagnostic labels and data exchange.

Relationship to VEA/MRCA decision-making standards. While the SOP creates a medical threshold (reasonable hypothesis), it does not itself alter the statutory legal tests for entitlement under the VEA or MRCA. It provides the RMA’s view of medical-scientific evidence to assist in establishing causation. Actual entitlement determinations remain governed by the statutory provisions of the VEA and MRCA, procedural rules, and any evidentiary or legal standards those Acts set. The SOP therefore interacts as a normative input into the statutory decision-making apparatus rather than as an autonomous legal rule displacing those Acts.

Administrative law and review. The SOP does not discuss merits review or judicial review processes. However, because it is a statutory instrument used in administrative decision-making, decisions that rely on it can be subject to administrative review channels under the relevant Acts and judicial review for jurisdictional error in the usual courts, subject to the procedural and substantive law external to this instrument. The instrument does not alter those pathways.

Health, privacy, and record disclosure laws. Implementation of the SOP in claims will typically require disclosure of medical records and service records. Those activities will interact with privacy laws (for example the Privacy Act 1988 and health records legislation) and potentially with Freedom of Information regimes when claimants seek records. The SOP does not address these regimes; practitioners must observe applicable record disclosure and privacy obligations outside the SOP.

Criminal and civil law boundaries. The SOP does not create civil liabilities or criminal offences. Where conduct relating to a claim involves alleged fraud or false representation, the relevant criminal or civil provisions in other legislation would apply. Those interactions are therefore external; the SOP informs the medical assessment but does not confer new legal sanctions.

Transitional and repeals. Section 4 repeals the 2014 thoracic and lumbar spondylosis SOPs. That repeal changes which SOP is operative for claims arising after commencement (s 2 and s 4). Practitioners must check transitional application in the VEA/MRCA context (the instrument does not itself describe transitional provisions beyond repeal and commencement).

Instrument identification and dates. The Statement of Principles is titled "Statement of Principles concerning thoracolumbar spondylosis (Reasonable Hypothesis) (No. 13 of 2023)" (s 1) and is dated 27 February 2023; it commenced on 27 March 2023 (s 2). The instrument was made under subsection 196B(2) of the VEA (s 3). The RMA Chairperson signed with the Common Seal (cover pages).

Repeal of predecessor instruments. Section 4 explicitly repeals two earlier RMA instruments: the Statement of Principles concerning thoracic spondylosis No. 64 of 2014 (Federal Register number provided) and the Statement of Principles concerning lumbar spondylosis No. 62 of 2014 (Federal Register number provided). The text identifies those Instruments by number and Federal Register reference. The repeal is unconditional in the instrument text; no transitional clauses are articulated in this instrument.

No amendments recorded in the instrument itself. The instrument text as provided does not include any internal amendment history beyond the repeal of the two 2014 SOPs and its own commencement. There are no listed later amendments or revisions inside the text supplied. The instrument therefore represents the operative 2023 consolidation replacing the two earlier SOPs.

Implication for application dates. The instrument's commencement date (s 2) is explicit. Practitioners must therefore apply the 2023 SOP from and after 27 March 2023 to claims within the statutory application identified in s 5. The instrument does not explain retrospective application rules for claims lodged prior to commencement; those are determined by the VEA/MRCA statutory framework rather than by the SOP text supplied.

No legislative amendment history supplied. The instrument does not contain a history of legislative amendments to the VEA or MRCA or other Acts that influenced this SOP. It references the enabling provision (s 196B(2) of the VEA) as the authority for making the SOP, but does not discuss prior amendments to that enabling provision.

Administrative provenance. The instrument records its administrative provenance: made by the Repatriation Medical Authority and sealed under the Chairperson's direction (cover pages). It does not provide an explanatory memorandum or second reading speech within the text provided; therefore the only record of rationale in the instrument is the RMA's view that there is "sound medical-scientific evidence" indicating that thoracolumbar spondylosis and death from it can be related to relevant service (s 8). The instrument does not include a legislative or regulatory history note beyond the repeal of the earlier SOPs.

Practical effect of the repeal. By repealing the earlier thoracic and lumbar SOPs, the RMA has consolidated or replaced the prior separate instruments with a single thoracolumbar SOP. The instrument itself does not set out transitional arrangements or savings provisions; administrators and practitioners should confirm whether the Department of Veterans' Affairs has procedural guidance about how claims spanning the repeal/commencement should be treated.

No cases or litigation recorded in the instrument. The Statement of Principles text does not refer to any judicial decisions, litigation history, or legal proceedings concerning thoracolumbar spondylosis or the RMA’s earlier SOPs. It contains no case citations and does not report any judicial interpretation of its provisions.

Role of SOPs in adjudicative disputes. Although no litigation history is recorded in the instrument, SOPs like this one are used as medical-evidentiary benchmarks in administrative decisions under the VEA and MRCA. Decisions that rely on SOPs can be the subject of merits review or judicial review in the usual administrative law forums, but the instrument itself does not document such proceedings.

Potential avenues for dispute (observations grounded in instrument structure). The SOP establishes concrete, definitional, and timing-based thresholds (for example clinical onset definitions, cumulative exposure thresholds, and trauma timing rules). In practice, these thresholds may give rise to disputes over medical interpretation and factual chronology in claims: e.g. when clinical onset occurred as assessed by a registered medical practitioner, whether imaging evidence establishes degenerative change, whether exposure thresholds are met, or whether trauma met the Schedule’s detailed criteria. Because the instrument is silent about litigation or appeals, any such disputes would be litigated or reviewed under the processes set out in the VEA/MRCA or general administrative law, not within this instrument.

No reported judicial interpretation to guide application. The absence of cited cases in the SOP means decision-makers must apply the text without statutory interpretative guidance from the instrument itself. Where ambiguities or contested medical questions arise, adjudicative bodies or courts may be asked to interpret the SOP’s provisions in the context of a claim; the instrument does not preclude that, but provides no record of precedent.

Record-keeping of future litigation. This SOP does not create a litigation register. Practitioners seeking litigation history will need to search administrative decisions, tribunal records or court judgments external to the instrument. The instrument itself is not a source of judicial material.

Evidentiary definitions that work against late or sparse records. The SOP ties diagnosis to both clinical manifestations and imaging evidence (s 7(2)(a)-(b)) and defines clinical onset as the point back from the first date of imaging confirming thoracolumbar spondylosis to when persistent symptoms began, as assessed by a registered medical practitioner (Schedule, clinical onset). This creates a practical requirement for contemporaneous medical documentation of persistent symptoms and an imaging report. Where claimants lack early clinical notes or imaging dates, proving the clinical onset point may be difficult and can defeat an otherwise plausible service connection.

Timing windows and latency rules. Many factors require specific timing: intra-articular fracture, non-viral infection, disc prolapse and spinal fusion must be at least 6 months before clinical onset to qualify as factors (s 9(3)-(4), (7), (12)). Trauma must be at least 6 months before clinical onset, and the trauma event must have occurred within 20 years before clinical onset (s 9(10) and Schedule definition). Subsection 9(13)-(15) set cumulative exposure windows within 10 or 25 years before clinical onset. Claimants with exposures outside these look-back windows may be unable to rely on those factors even if exposures were service-related.

Cumulative exposure evidentiary burden. The lifting and carrying thresholds are quantitative: cumulative lifting of at least 100,000 kg of 20 kg loads in any 10-year period (s 9(13)), and carrying for at least 3,800 hours of loads of at least 20 kg in any 10-year period (s 9(14)). Quantifying those sums or hours often requires detailed occupational histories or service records, not typically documented in clinical notes. Absent robust records, claimants will find it difficult to meet these numerical thresholds.

Lumbar-only distinctions. Some factors apply only to lumbar spondylosis (s 9(6), (8), (15), (24), (26), (33)). The instrument is titled thoracolumbar spondylosis, but those lumbar-only caveats matter: a claimant must correctly identify whether their condition is thoracic, thoracolumbar or lumbar to know which factors are in play. Misclassification can lead to missed factors or incorrect reliance.

Exclusions in the definition. The SOP excludes diffuse idiopathic skeletal hyperostosis, Scheuermann disease and simple disc bulging without other degenerative signs (s 7(4)). A diagnosis carded as "spondylosis" but with predominant features of one of these excluded entities may not be covered, which can be a surprising evidentiary bar where radiology reports are ambiguous.

Interplay with other SOPs. Section 11 requires cross-application of other SOPs for referenced conditions. Practitioners must check whether a factor (for instance ankylosing spondylitis) triggers another SOP with different factor lists or timeframes. Failure to apply the cross-referenced SOP correctly may lead to errors in establishing nexus.

Clinical management and worsening provisions. Factor 37 is "inability to obtain appropriate clinical management for thoracolumbar spondylosis" and applies to clinical worsening (s 9(37) and context in s 9(19)-(37)). "Inability to obtain appropriate clinical management" is inherently fact-specific and may depend on contemporaneous records showing attempts to obtain care and systemic barriers. The SOP does not define what counts as "appropriate", so adjudicators will likely rely on medical judgement and evidence of access or denial of care; this creates evidentiary and interpretative risk.

Trauma definition thresholds. The Schedule defines trauma requiring symptom development within 24 hours and persistence for at least 7 days, unless specific medical interventions occurred (Schedule definition of trauma). Claims that rely on trauma where symptoms were delayed, masked by analgesia without good documentation, or where records of those post-trauma symptoms are absent may not satisfy the definition.

Obesity requires long-term measurement. "Being obese" is defined as BMI ≥30 and the factor requires at least 10 years before clinical onset (s 9(16) and Schedule). Establishing a historical BMI over a decade requires weight and height records across time. One-off measurements will not ordinarily suffice to prove duration.

Leg length inequality strictness. Leg length inequality requires at least 2 cm disparity that remains uncorrected and involves the limb in daily use (Schedule). Correction includes surgery or orthotic footwear. A claimant who intermittently used orthotics or whose inequality is measured slightly under 2 cm may not meet the threshold.

Operational aircrew hours. The factor for aircrew requires operational aircrew flying for at least 1,000 hours within 25 years before clinical onset and applies only to lumbar spondylosis (s 9(15), (33)). Service records must show those hours. Claims by non-operational aircrew or where flight hours are undocumented will not qualify on this basis.

Death and terminal event contribution. The SOP allows death to be attributed to thoracolumbar spondylosis where the disease contributed to a terminal event (s 7(9) and Schedule terminal event list). Establishing contributory causation between spondylosis and a terminal event (for example pneumonia) requires expert medical evidence linking the spinal condition to the terminal event; this can be contested and requires specialist opinions.

ICD coding is prescriptive but not definitive. The prescribed ICD-10-AM codes (s 7(6)-(8)) ensure coding consistency, but coding alone will not substitute for the clinical and imaging criteria. Relying on diagnosis codes without supporting medical evidence risks rejection.

Relevance to claims predating repeal. Because the instrument repeals prior 2014 SOPs (s 4), practitioners need to confirm which SOP applies to particular claims based on claim lodgement and decision dates under the VEA/MRCA framework. The instrument does not set out transition rules; omission of transitional guidance can trip advisers who assume an automatic carry-over.

As a checklist for advisers (lawyers, clinicians, claims officers) preparing or assessing claims under this SOP, focus on assembling evidence mapped to the instrument’s definitions, timing windows, and factor list.

1. Confirm the applicable SOP and dates.

• Verify the claim falls under s 120A VEA or s 338 MRCA (s 5), and ensure the claim date/decision date aligns with the SOP’s commencement (27 March 2023, s 2). Confirm that the 2014 thoracic and lumbar SOPs have been repealed (s 4) and that this SOP is the operative instrument.

2. Establish diagnosis per s 7.

• Obtain medical records showing clinical manifestations (local thoracolumbar pain and stiffness, or signs of thoracolumbar cord/nerve root compression) (s 7(2)(a)).
• Obtain radiology reports and images demonstrating degenerative change (disc space narrowing, osteophytes) and the imaging date (s 7(2)(b) and Schedule definition of imaging evidence). Remember the Schedule notes imaging usually post-dates clinical onset.

3. Document clinical onset precisely.

• Secure a treating registered medical practitioner’s opinion identifying the date of clinical onset using the Schedule’s definition (clinical onset is the point back from first imaging date to when symptoms were persistently present as assessed by a registered medical practitioner). Collect contemporaneous general practitioner notes, specialist notes, and allied health records to support persistence.

4. Identify and document at least one qualifying factor from s 9.

• Map each relevant factor to available evidence. Examples:
  • Prisoner of war: obtain POW documentation in service records (s 9(1), (19)).
  • Inflammatory joint disease: obtain rheumatology records confirming a diagnosis from the specified list (Schedule list and s 9(2), (20)).
  • Non-viral joint infection, intra-articular fracture, penetrating disc injury, disc prolapse: get surgical notes, hospital records, imaging reports with dates (s 9(3)-(4), (11)-(12) and Schedule definitions).
  • Spinal fusion: obtain operative report showing level relationships (s 9(7) and Schedule definition of spinal fusion).
  • Trauma: obtain incident reports, hospital emergency department notes documenting onset within 24 hours and persistence for ≥7 days or documentation of specified interventions (Schedule trauma definition and s 9(10)).
  • Lifting/carrying thresholds: assemble occupational duty statements, unit logs, trade records, witness statements, or employer records to quantify loads and hours (s 9(13)-(14), (31)-(32)).
  • Operational aircrew hours: obtain flight logs and service records confirming operational aircrew status and cumulative hours (s 9(15), (33)).
  • Obesity: obtain longitudinal weight and height measurements or medical records substantiating BMI ≥30 for at least 10 years (s 9(16) and Schedule BMI).
  • Acromegaly or Paget’s disease: obtain specialist endocrine or metabolic bone disease reports (s 9(17)-(18), Schedule).
  • Leg length inequality: obtain orthopaedic assessments documenting ≥2 cm uncorrected inequality and evidence of daily use (Schedule).
  • Inability to obtain appropriate clinical management: obtain records showing attempts to access care, referrals, waitlists or system barriers, dated contemporaneously (s 9(37)).

5. Link factor to relevant service per s 10.

• For each factor, document how it relates to the person's relevant service (Schedule defines relevant service types). For factors intended to establish material contribution or aggravation (subsections 9(19)-(37)), ensure the person’s thoracolumbar spondylosis was suffered or contracted before or during, but did not arise out of, their relevant service (s 10(2)). Prepare chronology tying factor occurrence to service timeframes.

6. Check for cross-SOP application (s 11).

• If any factor invokes a condition covered by another SOP (for example ankylosing spondylitis, gout, scoliosis), identify and collect supporting evidence for that condition and apply the corresponding SOP’s factors as in force. Obtain any specialist opinions required by the other SOPs.

7. Prepare medical opinions to meet the SOP thresholds.

• Ask treating specialists to address specifically: diagnosis per s 7; date of clinical onset per Schedule definition; whether imaging confirms degenerative change; whether the enumerated factor is present and its timing; and whether, in their opinion, the factor could reasonably be connected to relevant service. For death claims, obtain an opinion linking thoracolumbar spondylosis to the terminal event (s 7(9) and Schedule terminal event list).

8. Record keeping and quantification.

• For cumulative exposure factors (lifting totals, carrying hours, aircrew hours), produce worked calculations, corroborated by records or sworn statements where records are partial. For obesity duration, collate serial weight/height measures, medical centre notes, or employment medicals showing BMI trajectory. For leg length inequality, obtain objective measurement reports.

9. Anticipate counter-arguments and prepare rebuttal evidence.

• For exclusions (s 7(4)), ensure radiology reports discriminate between excluded conditions and degenerative spondylosis. If trauma is relied upon, ensure compliance with the Schedule’s symptom-onset and persistence criteria, or documentary evidence of the listed medical interventions that relax the persistence requirement.

10. Administrative process and submissions.

• Frame submissions to the DVA or MRCA referencing the specific sections: state diagnosis (s 7), identify relevant factor(s) (cite exact s 9 clauses), show relation to relevant service (s 10), and cite cross-SOP obligations where relevant (s 11). Attach medical and service records, specialist reports, imaging, and calculations.

11. Record limitations and evidentiary gaps.

• Where records are incomplete, document efforts to obtain missing records (requests to Defence, FOI, hospital records), and where possible obtain expert evidence about how, in the absence of records, the clinical picture and known service exposures nonetheless meet the SOP thresholds.

12. For death claims, secure cause-of-death materials.

• Obtain death certificate, coroner’s reports if applicable, hospital records preceding death, and an expert opinion linking thoracolumbar spondylosis to the terminal event(s) listed in the Schedule (s 7(9)). Show how spondylosis contributed to terminal physiology where possible.

13. Use ICD coding as a supporting tool.

• Where diagnosis uses an ICD-10-AM code listed in s 7(6), include coded data but do not rely on it alone. Ensure clinical and imaging evidence accompanies coding.

14. Maintain contemporaneous chronology.

• Prepare a clear timeline aligning clinical onset, imaging dates, service exposures, surgical/intervention dates, and the occurrence of any qualifying factor(s) to satisfy the SOP’s temporal conditions (Schedule and s 9).

By following these steps, the evidence submitted will be tailored to the precise definitions and thresholds in the SOP, improving the chance that the RMA’s reasonable hypothesis threshold will be identified in administrative decision-making.