Statement of Principles concerning traumatic contusion or haematoma (Balance of Probabilities) (No. 44 of 2024)

The instrument is organised around a small number of core legal and medical concepts. Those concepts determine what evidence will be material to a claim under the VEA or MRCA provisions referenced in s 5.

Condition definition and scope. Traumatic contusion or haematoma is defined as a blood collection in skin, tissue or organ resulting from application of physical force with tissue damage and internal bleeding (s 7(2)(a)). The instrument provides an inclusive list of organs and anatomical sites that are within scope, such as heart, pericardium, lung, pleura, liver, spleen, kidneys, bone, joint, eye and orbit (s 7(2)(b)). There are explicit exclusions: blood collections associated with a fracture, and blood collections associated with subarachnoid, subdural, extradural haemorrhage or cerebrovascular accident are outside the SoP (s 7(2)(c)(i)-(ii)). The instrument contains clinical notes that refine the clinical picture: if the haematoma affects only the brain, a different SoP (moderate to severe traumatic brain injury) is to be preferred (note to s 7); haematomas can enlarge due to persistent bleeding (note to s 7); and haematomas compressing surrounding structures, including causing acute compartment syndrome, are to be considered integral manifestations (note to s 7).

Death. The Statement treats death from a traumatic contusion or haematoma as included where the contusion or haematoma contributed to a terminal event or condition (s 7(3)). The Schedule defines "terminal event" by listing proximate or ultimate causes, including pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (Schedule 1).

Causation standard and evidence basis. The RMA records that its view, founded on "sound medical‑scientific evidence available", is that it is more probable than not that the condition can be related to relevant service rendered by veterans or members under the VEA or MRCA (s 8). The instrument’s title specifies the balance of probabilities standard. The SoP therefore sets out the factual circumstances in which connection is, on balance, to be regarded as established.

Quantified factual pathways. The instrument reduces the universe of qualifying factual scenarios to two pathways (s 9):

• Recent trauma path: trauma involving the affected site within the 24 hours before clinical onset (s 9(1)). This creates a tight temporal window between the physical force and clinical symptom onset.
• Failure of management path: inability to obtain appropriate clinical management for the contusion or haematoma before clinical worsening (s 9(2)). Section 10(2) constrains the application of this pathway to situations of material contribution or aggravation where the contusion/haematoma was suffered or contracted before or during, but did not arise out of, the person's relevant service.

Interaction with other Statements. If an identified factor refers to an injury or disease that is already the subject of another SoP, the other SoP’s factors apply in accordance with that instrument (s 11). This establishes a mechanism for cross‑reference and prevents inconsistent overlapping application.

Definitions that matter. "Relevant service" is defined in Schedule 1 to mean eligible war service (other than operational service) under the VEA, defence service (other than hazardous service and British nuclear test defence service) under the VEA, or peacetime service under the MRCA (Schedule 1). "Traumatic contusion or haematoma" is the same as in s 7(2) (Schedule 1). "Terminal event" is also defined (Schedule 1).

Procedural footprint. The instrument is an RMA Statement of Principles under s 196B(3), intended to be used in the statutory decision‑making processes governed by the VEA and MRCA references in s 5. It is a medical‑science based statement of the factual circumstances that, on balance, satisfy causal connection. The instrument does not, itself, set out the administrative steps decision‑makers must follow or any appeal or review mechanisms.

This Statement of Principles affects a narrowly defined set of actors within the veteran and service compensation system.

Primary claimants. It applies to persons lodging claims "to which section 120B of the VEA or section 339 of the MRCA applies" (s 5). Those are statutory referral points; the SoP will be engaged where the decision or tribunal process invokes those sections as the relevant claim type. The instrument therefore affects veterans and members of the Forces seeking entitlements under those statutory provisions. The instrument does not purport to apply outside claims within those statutory points (s 5).

Veterans and members as to relevant service status. The instrument’s operative causation requires the contusion or haematoma be related to "relevant service" as defined in Schedule 1. Relevant service encompasses eligible war service (other than operational service) under the VEA, defence service (other than hazardous service and British nuclear test defence service) under the VEA, and peacetime service under the MRCA (Schedule 1). That definition excludes certain service categories; persons whose service falls outside these phrases are not within the instrument’s scope.

Medical practitioners and expert witnesses. Clinicians preparing reports for claimants or for decision‑makers will be directly affected because the SoP prescribes the clinical facts that establish a link on the balance of probabilities. The two alternative factual routes in s 9 indicate the kinds of clinical history, timing, and management evidence that will be decisive.

Decision‑makers and administrators. Statutory decision‑makers and their medical assessors who resolve connection under s 120B of the VEA or s 339 of the MRCA will use the SoP factors when determining whether traumatic contusion or haematoma is connected to relevant service (s 5, s 9). The RMA’s recorded medical‑scientific view in s 8 is designed to be a reference point for those determinations.

Parties affected by exclusions or overlap. Where a contusion is only in the brain, the instrument’s note directs preference to the moderate to severe traumatic brain injury SoP (note to s 7). Similarly, blood collections associated with fracture, or certain intracranial haemorrhages, are excluded (s 7(2)(c)). If a factor in s 9 refers to an injury or disease covered by another SoP, the other SoP’s factors apply (s 11). Practitioners and advocates must therefore be alert to potential SoP overlap or exclusion to select the applicable SoP.

Indirectly affected parties. The repeal of the prior external bruise SoP No. 6 of 2016 (s 4) transfers the evaluative regime for claims previously assessed under that instrument to the new Statement. Administrative units handling legacy claims will need to ensure they apply the correct, current SoP.

Who does not have procedural rights in the instrument. The Statement itself contains no procedural entitlement or penalty provisions; it does not grant independent rights or create enforcement mechanisms beyond its role as a medical‑scientific instrument for causation determinations. The wider adjudicative rights (reviews, appeals) remain in the VEA and MRCA statutory frameworks, which are referenced but not reproduced in this instrument (s 5).

The Statement of Principles primarily prescribes factual thresholds and definitional clarifications rather than procedural duties or statutory rights. Nonetheless, it creates binding factual tests that stand between claimants and an affirmative connection finding.

Factual preconditions for a finding. The central conceit of the instrument is the mandatory nature of the factual predicate: before it can be said that, on the balance of probabilities, traumatic contusion or haematoma or death from that condition is connected with relevant service, at least one of the factors in s 9 must exist (s 9). That is an expressed requirement in statutory language. Consequently, claimants bear the practical task of establishing one of those factors in relation to the relevant service nexus described in s 10.

Relationship to service requirement. Section 10(1) requires that the existence of any factor in s 9 be related to the relevant service rendered by the person. The instrument therefore imposes a relational duty on the claimant to demonstrate connection of the factual factor to the service. The precise legal mechanisms for proving that relationship (for example documentary, medical expert opinion, or witness evidence) are not set out in the instrument; the text requires the relationship but leaves evidential detail to the decision‑making process under the VEA/MRCA frameworks (s 5, s 10).

Temporal and causal limits on management failure pathway. Section 10(2) narrows the circumstances in which the s 9(2) factor (inability to obtain appropriate clinical management) can be relied upon. It applies only to material contribution or aggravation of the contusion where the contusion was suffered or contracted before or during, but did not arise out of, the person's relevant service. This wording imposes a threshold causal and temporal structure: s 9(2) cannot be used in all scenarios, and claimants must satisfy both the antecedent existence of contusion and the specified relationship to service. The instrument thereby restricts the contexts in which lack of appropriate clinical management will be a route to a connection finding.

Cross‑application duty. Section 11 creates a duty‑like mechanism: if a factor in s 9 refers to an injury or disease covered by another SoP determined under s 196B(3), then the factors in that other SoP apply in accordance with their terms. Practitioners and decision‑makers therefore have to identify whether s 9 factors intersect with other SoPs and then apply the other instruments’ factors, which alters what must be established.

Rights implicit in the definitions. The instrument defines "death from traumatic contusion or haematoma" to include death from a terminal event to which the contusion materially contributed (s 7(3) and Schedule 1). That gives claimants a pathway to connection where the contusion has contributed to a terminal event such as pneumonia or respiratory failure (Schedule 1). This is a substantive expansion over a narrow reading that would ignore contributory terminal events.

Limits on duties and absence of penalties. The instrument does not itself create criminal or civil penalties, procedural powers to compel evidence, or administrative sanctions. It is a medical‑scientific determinant to be used in the statutory claims processes. Any duties to provide information, attend medical examinations, or penalties for false statements must be found in the VEA or MRCA provisions referenced in s 5; they are not created or modified here.

Practical effect on documentary duties. Because the instrument requires proof of one of two factual routes (s 9), claimants, their legal representatives and medical advisors will effectively be obliged to furnish evidence in support of those elements: clinical histories establishing trauma within 24 hours of symptom onset (s 9(1)), or contemporaneous medical records showing inability to obtain appropriate clinical management before clinical worsening (s 9(2)) together with evidence of the requisite relationship to relevant service (s 10). The instrument structures what evidence will be decisive, even though it does not itself prescribe evidentiary procedures.

The instrument does not create or specify any penalties, fines, criminal offences, or administrative enforcement mechanisms. There are no enforcement provisions in the Statement of Principles text. Its legal character is that of a medical‑scientific instrument used to determine causal connection in claims falling within s 120B of the VEA or s 339 of the MRCA (s 5), not an enforcement statute.

Enforcement through decision outcomes. The instrument’s effect on enforcement is indirect: it alters the factual criteria used by decision‑makers in the relevant claims processes. A finding that a condition is connected with relevant service under the operative statutory scheme will enable entitlement outcomes in accordance with the VEA or MRCA. Conversely, failure to establish any of the required s 9 factors, or failure to show the relationship to relevant service required by s 10, will lead to a negative causation finding within those statutory schemes. The instrument itself does not state the remedial consequences of those determinations; they remain within the VEA/MRCA frameworks referenced in s 5.

No investigatory powers conferred. The instrument does not grant new investigatory powers to the RMA or other agencies. It is a statement of principles and definitions; it neither authorises compulsory information gathering nor prescribes compliance mechanisms beyond the established processes of the VEA/MRCA regime.

Administrative effect on claims management. Practically, the RMA’s medical position (s 8) and the s 9 factors will be used by administrators, medical assessors and adjudicators to accept or reject connection. This shapes which documentary and expert medical evidence will be decisive and therefore which claims will be advanced or discontinued. The instrument’s repeal of the prior SoP (s 4) may change outcomes in some marginal cases where the earlier instrument’s criteria differed, but the instrument does not state transition or savings rules; those are to be found, if at all, in the broader statutory or administrative regimes outside the instrument.

Appeal and review routes not addressed. The instrument does not set out appeal or review rights or time limits. Those procedural rights are governed by the VEA and MRCA frameworks referenced in s 5, not by this instrument.

The instrument situates itself inside the statutory architecture of the VEA and MRCA but does not reproduce those statutes. Its interactions are therefore limited to the functions and references it makes.

Statutory foundation. This Statement of Principles is made under subsection 196B(3) of the Veterans' Entitlements Act 1986 (s 3). It is intended to be applied in the context of claims that engage s 120B of the VEA or s 339 of the MRCA (s 5). The instrument thus functions as an RMA medical‑scientific determination invoked by those statutory claim provisions.

Interplay with the VEA and MRCA claims processes. The instrument specifies the factual thresholds for connection for claims to which s 120B or s 339 applies (s 5). It does not stand alone; claimants must still proceed under the procedural and substantive rules of the VEA and MRCA. The Statement does not define the consequences of a positive or negative causal finding; those consequences derive from the substantive provisions of the VEA and MRCA and their implementing regulations. Therefore, the Statement interacts with those Acts by supplying medical criteria for causation, but it leaves statutory entitlements and remedies to the referenced Acts.

Cross‑application with other RMA Statements. Section 11 creates a specific mechanism for interaction among Statements of Principles. If a s 9 factor refers to an injury or disease covered by another SoP determined under s 196B(3) of the VEA, then the factors in that other SoP apply in accordance with its terms (s 11). This prevents conflicting causation frameworks where conditions overlap and requires harmonised application across RMA instruments.

Replacement and repeal. The instrument expressly repeals the Statement of Principles concerning external bruise No. 6 of 2016 (Federal Register No. F2016L00005) (s 4). That repeal alters which RMA SoP will govern claims previously evaluated under the 2016 instrument. Any transition issues are not addressed in the text; they will depend on administrative practice and the operative provisions of the VEA and MRCA about retrospective or transitional application.

Limitation of scope relative to other medical conditions. The instrument’s exclusions and note‑directives create de jure demarcation lines with other medical conditions and their SoPs. For example, the instrument excludes intracranial haemorrhages and cerebrovascular accidents (s 7(2)(c)(ii)) and indicates that where a haematoma affects only the brain, the moderate to severe traumatic brain injury SoP is preferred (note to s 7). That instructs decision‑makers and medical assessors to consult other SoPs where appropriate.

No express conflict resolution provision. The instrument does not provide a general rule for resolving conflicts between this SoP and other instruments, beyond the targeted cross‑application in s 11. Broader conflict resolution would be determined by the statutory frameworks of the VEA and MRCA and administrative practices.

Definitions align with statutory references. The Schedule defines "relevant service" in terms that mirror the VEA and MRCA categories (Schedule 1). Those definitions will be applied by decision‑makers in tandem with the VEA and MRCA definitions and interpretive frameworks.

In sum, the instrument is an RMA medical‑scientific input into the broader statutory machinery of veterans’ entitlements and military compensation. It interacts with other instruments and statutes by supplying narrowly framed factual criteria for causation while leaving substantive entitlement, remedy and procedural mechanisms to the referenced Acts.

This Statement of Principles is identified as No. 44 of 2024 and is dated 21 June 2024, with commencement set for 23 July 2024 (front matter; s 2). The instrument is made by the Repatriation Medical Authority and signed by the Chairperson (front matter). Its recorded statutory authority is subsection 196B(3) of the Veterans' Entitlements Act 1986 (s 3).

Express repeal. The instrument expressly repeals the Statement of Principles concerning external bruise No. 6 of 2016, which was published as Federal Register of Legislation No. F2016L00005 (s 4). The repeal indicates the RMA has updated its approach to the medical‑scientific factors that establish connection for contusion/haematoma‑related claims. The instrument does not set out any savings or transitional provisions for matters decided while the 2016 instrument was in force; absent such language, application to claims will follow the commencement date and the statutory frameworks under the VEA and MRCA.

Instrument identity and placement. The title and numbering (No. 44 of 2024) signal a chronological spot in the RMA’s output of Statements for that year. The instrument’s content replaces the earlier external bruise instrument for the relevant class of claims; it specifies a different diagnostic scope (wider organ list, explicit exclusions) and a different set of causal factors (the two s 9 routes). Any subsequent amendments to this Statement would be recorded by the RMA in later instruments under the same statutory head (s 3).

No other amendments recorded in the text. The instrument itself contains no embedded amendment or savings clauses and records no prior amendment history beyond the repeal of the 2016 instrument. If administrative practice provides for transitional handling of claims that straddle commencement, that practice is not set out in this instrument.

Administrative signatories and date. The front matter records the instrument is dated 21 June 2024 and is made by Professor Terence Campbell AM as Chairperson on behalf of the Repatriation Medical Authority. That identifies the RMA official authorising the instrument and the date of determination.

Schedule and notes as part of amendment record. The instrument’s Schedule 1 contains definitions that are integral to interpretation, including the newly expressed definition of "relevant service" and the list of terminal events. Those definitional choices are part of the amendment history in the sense that they replace or refine language that may have appeared in the 2016 instrument.

Practical note for administrators. Repeal of the 2016 external bruise SoP requires administrators, medical assessors and legal advisers to replace reliance on the 2016 instrument with No. 44 of 2024 from the commencement date. The instrument does not itself direct how legacy decisions should be reviewed, nor does it identify which claims already finalised are subject to reconsideration; those procedural matters will be determined by the VEA/MRCA regimes and administrative policy.

The Statement of Principles text supplied contains no reference to any litigation history. It does not mention any cases, judicial decisions or tribunal determinations that have interpreted or challenged the RMA’s prior or current Statements. The front matter and body record only administrative details: that the instrument is determined by the Repatriation Medical Authority under s 196B(3) of the VEA, dated 21 June 2024, and commencing 23 July 2024 (front matter; s 2). The instrument also repeals the prior external bruise SoP No. 6 of 2016 (s 4).

Implication for litigators and advocates. Because no litigation history is recorded in the instrument itself, practitioners must look to the VEA, MRCA and any relevant tribunal or court decisions outside this document for authoritative interpretations of how SoPs are applied in contested decisions. The instrument’s silence on litigation means it does not provide judicial gloss or precedent; its content is a medical‑scientific statement intended to be applied administratively and to guide adjudicators. Any judicial or tribunal engagement with this particular SoP will therefore occur after commencement and will be found in case law rather than inside the instrument.

Potential areas where litigation could arise. The instrument creates discrete legal questions that could be litigated in the future, for example:

• The interpretation of the 24‑hour temporal window in s 9(1): whether "within the 24 hours before clinical onset" is measured from first symptom, first presentation, or first clinical diagnosis.
• The meaning of "inability to obtain appropriate clinical management" in s 9(2): what constitutes "appropriate" and what evidence will satisfy inability to obtain it.
• The application and scope of s 10(2): how to apply the "suffered or contracted before or during (but did not arise out of) the person's relevant service" limitation.
• The relationship between this SoP and overlapping SoPs under s 11: where two SoPs potentially cover the same injury, how tribunals should choose or harmonise them.

None of these interpretive issues are decided within the text. Absent judicial decisions in the instrument, practitioners must be prepared to litigate or otherwise obtain authoritative administrative interpretations post‑commencement as matters arise.

No recorded appeals or transitional jurisprudence. The instrument does not narrate or record appeal outcomes relating to the repealed 2016 SoP or this new instrument. For current litigation history, practitioners must consult tribunal and court records and administrative guidance outside this instrument.

The Statement of Principles is compact but contains several features that can produce unexpected outcomes if not read closely. These are practical "watch outs" drawn directly from the instrument's text.

Narrow temporal window for direct trauma. The core trauma pathway requires "having trauma involving the affected site within the 24 hours before clinical onset" (s 9(1)). That is a short window. Claims where sequelae appear after more than 24 hours from the identified trauma are not covered by s 9(1) unless another relevant factor applies. Practitioners must therefore ensure clinical histories clearly document timing of trauma and onset to within 24 hours.

Exclusion of fracture‑associated blood collections. The instrument expressly excludes "blood collections associated with a fracture" (s 7(2)(c)(i)). If the haematoma is part of or associated with a fracture, this SoP is not the applicable instrument. That exclusion can redirect a claim to other injury categories or SoPs, and is a frequent factual demarcation in trauma medicine.

Intracranial haemorrhage exclusions and TBI cross‑reference. The Statement excludes blood collections associated with subarachnoid, subdural, extradural haemorrhage or cerebrovascular accident (s 7(2)(c)(ii)). The accompanying note says that if the traumatic haematoma only affects the brain, then the moderate to severe traumatic brain injury SoP should be preferred (note to s 7). Practitioners must be careful to select the correct SoP where brain involvement is primary; mis‑selection can prejudice an outcome.

Limited scope of the clinical management pathway. The second factor in s 9 is "inability to obtain appropriate clinical management for traumatic contusion or haematoma before clinical worsening" (s 9(2)). Section 10(2) constrains s 9(2): it applies only to material contribution to, or aggravation of, traumatic contusion or haematoma where the person's contusion was suffered or contracted before or during, but did not arise out of, the person's relevant service. The phraseology means s 9(2) is not a free‑standing route for contusions that arise out of service in the ordinary course. The drafting is not plain‑language simple and has a built‑in causal limit: s 9(2) addresses inability to secure care in situations where an antecedent contusion existed but did not arise out of service, yet the contusion is materially contributed to or aggravated in the relevant service context. Practitioners should not assume s 9(2) applies to every failure‑to‑treat scenario.

Proof focus on relation to "relevant service". Whatever the factual route used (s 9(1) or s 9(2)), s 10(1) requires that the factor be related to the person's relevant service. "Relevant service" is itself defined narrowly in the Schedule (Schedule 1): eligible war service excluding operational service, defence service excluding hazardous and British nuclear test defence service, and peacetime service under the MRCA. If the claimant's service does not fall within these categories, the SoP is not applicable. Practitioners must check service classifications carefully.

Cross‑application traps. Section 11 mandates that if a s 9 factor refers to an injury or disease in another SoP, the other SoP's factors apply. This can produce unexpected cross‑references. For example, where an initial finding of trauma also triggers an injury type governed by another SoP, the other SoP’s factors become operative. Failure to identify cross‑references may lead to an incorrect evidentiary strategy.

Death causation requires contribution to a terminal event. For death claims, the SoP includes death "from a terminal event or condition that was contributed to by the person's traumatic contusion or haematoma" (s 7(3)). The Schedule defines terminal event with examples (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). A finding of contribution will require evidence linking the contusion to the terminal event; mere temporal proximity may be insufficient. The SoP places the onus on causal contribution, not mere association.

Replaced prior SoP without savings language. The instrument repeals the 2016 external bruise SoP (s 4), but contains no express transition provisions in the text provided. This can create administrative uncertainty for claims initiated before commencement or for decisions made under the prior SoP. Practitioners should check administrative policy or the VEA/MRCA frameworks for guidance on handling pre‑commencement matters.

Ambiguity in clinical terms. Phrases such as "appropriate clinical management" and "clinical onset" are not defined in the instrument. That leaves room for differing clinical and adjudicative interpretations, and for disputes about whether a particular standard of care or timing metric has been met. Expect these to be the locus of disagreement in contested claims.

Standard of proof and medical basis. Section 8 records that the RMA is of the view that, on the "sound medical‑scientific evidence available", it is more probable than not that a relation to relevant service exists. The SoP therefore channels adjudication to the balance of probabilities standard. Claimants and medical experts should frame opinions accordingly. However, "sound medical‑scientific evidence available" is a meta‑statement not a procedural proof requirement; practitioners will still need to demonstrate facts in the statutory process.

No penalties or procedural rules in SoP. The lack of procedural or penalty provisions can lull practitioners into assuming flexibility; in practice, claim outcomes will hinge on the VEA/MRCA procedures outside the SoP. Do not treat the SoP as governing procedural rights or obligations.

The Statement of Principles establishes which factual matters must be established for a finding of connection. Compliance therefore means presenting admissible, probative evidence mapped to the instrument’s elements and definitions. The following practical steps describe the evidentiary and procedural posture that claimants, medical practitioners and advisers should adopt when advancing or assessing claims that invoke this SoP.

1. Confirm applicability to the claim. First, verify the claim is one "to which section 120B of the VEA or section 339 of the MRCA applies" (s 5). If the statutory basis for the claim does not invoke those sections, this SoP is not the governing medical instrument. Also confirm the applicant’s service classifies as "relevant service" under Schedule 1 (eligible war service other than operational service; defence service other than hazardous service and British nuclear test defence service; peacetime service under the MRCA).

2. Identify the correct SoP for the injury. Determine whether the clinical presentation is a traumatic contusion or haematoma as defined in s 7(2)(a)-(b). Check the exclusions in s 7(2)(c). If the haematoma is associated with a fracture or is one of the listed intracranial haemorrhages, this SoP will not apply. If the haematoma is only in the brain, prefer the moderate to severe traumatic brain injury SoP as directed by the note to s 7.

3. Assemble evidence for one of the s 9 factors. The instrument requires at least one of the two factors in s 9:

• For s 9(1) (trauma within 24 hours before clinical onset): compile contemporaneous or retrospective clinical notes documenting the time of physical force or trauma and the time of first clinical symptoms or onset. Emergency department records, ambulance reports, injury reports, imaging timestamps and clinician notes that timestamp onset and trauma are directly relevant. Precisely document the 24‑hour chronology because the instrument’s route is temporally strict.

• For s 9(2) (inability to obtain appropriate clinical management before clinical worsening): gather records that evidence attempts to obtain care (referral records, appointment logs, correspondence, emergency department triage notes), and evidence of clinical worsening and timing. Because the instrument does not define "appropriate clinical management", provide clinical opinions from treating practitioners or specialists explaining the standard of care, why timely management was required, and why the lack of access materially contributed to worsening.

4. Satisfy the relationship to relevant service. Section 10(1) requires the factor relied on to be related to the person's relevant service. Provide documentary evidence linking the traumatic event or the inability to obtain management to circumstances of service. Where s 9(2) is relied upon, ensure compliance with s 10(2) by demonstrating that the contusion was suffered or contracted before or during, but did not arise out of, the person's relevant service, and that lack of appropriate management in the service context materially contributed to or aggravated the contusion.

5. Account for cross‑application. If a s 9 factor refers to an injury or disease covered by another RMA SoP, identify that other SoP and prepare the evidence required by it, because s 11 makes those other SoP factors apply in accordance with their terms. Provide cross‑referenced clinical opinions where conditions overlap.

6. Prepare expert medical opinion in SoP terms. Because s 8 frames the RMA’s judgment as being on the balance of probabilities grounded in "sound medical‑scientific evidence", medical expert reports should (a) state the causal opinion on balance of probabilities, (b) link clinical findings to the SoP factors (timing, management, relation to service), and (c) address exclusions listed in s 7(2)(c). Experts should explicitly state whether the case meets s 9(1) or s 9(2), and explain how s 10 is satisfied.

7. For death claims, map contribution to a terminal event. If the claim involves death, the SoP requires that the contusion or haematoma contributed to a terminal event as defined in Schedule 1 (e.g. pneumonia, respiratory failure, cardiac arrest). Medical evidence must link the contusion causally to the terminal event on balance of probabilities.

8. Document timeline and chain of causation. Because timing is central to s 9(1) and s 9(2), provide a clear timeline of trauma, clinical onset, attempts to obtain care, clinical intervention dates and deterioration. Where contemporaneous records are lacking, obtain credible retrospective accounts and corroborating material.

9. Anticipate the exclusion categories. If the haematoma is associated with a fracture or with one of the excluded intracranial haemorrhages, do not attempt to shoehorn the case under this SoP; instead identify the appropriate injury category or SoP.

10. Engage administrative avenues for guidance. Because the instrument replaces a prior SoP (s 4) and contains no procedural or transitional rules, administrative practice may provide guidance on how to treat claims that straddle the commencement date. Consult the decision‑maker’s current practice or published guidance in the VEA/MRCA administration.

11. Preserve records and contemporaneous evidence. Given the SoP’s reliance on timing and management access, retain medical records, appointment logs, and contemporaneous statements, including service documentation that evidences the circumstances of trauma or access to care during service.

Limitations of this compliance guidance. This instrument supplies the factual criteria but does not prescribe the procedural steps, time limits, or appeal mechanisms for claims under the VEA or MRCA. Practitioners must integrate the SoP evidence strategy with the procedural requirements of the governing claim provisions cited in s 5.

Overall, compliance requires tightly focused medical and service documentation mapped to the instrument’s temporal, causal and definitional predicates, with particular attention to the 24‑hour trauma window, the constrained scope of the clinical management pathway, and the specified exclusions.