Statement of Principles concerning visual refractive error (Balance of Probabilities) (No. 36 of 2025)

Statement of Principles concerning Visual Refractive Error (Balance of Probabilities) (No. 36 of 2025) is a legislative instrument made by the Repatriation Medical Authority under subsection 196B(3) of the Veterans’ Entitlements Act 1986 (VEA). It replaces the earlier Statement of Principles concerning myopia, hypermetropia and astigmatism (Balance of Probabilities No. 10 of 2016), which it repeals in section 4. The instrument comes into force on 25 March 2025.

Its mechanical function is to specify the medical‑scientific factors that must exist before it can be said, on the balance of probabilities, that a visual refractive error - or death from such an error - is connected with the circumstances of a person’s relevant service under the VEA or the Military Rehabilitation and Compensation Act 2004 (MRCA). It applies to claims under section 120B of the VEA and section 339 of the MRCA, both of which use the balance‑of‑probabilities standard.

The instrument defines “visual refractive error” as a group of eye diseases where the refractive power of the optical system in a relaxed state does not match the length of the eyeball, specifically including myopia, hyperopia, astigmatism and anisometropia. It expressly excludes presbyopia (age‑related farsightedness). It also sets out extended definitions for each subtype, including clinical notes and ICD‑10‑AM codes (though the instrument makes clear the meaning is that given in its own text, not merely the code).

Section 8 states that the Authority is satisfied, on sound medical‑scientific evidence, that it is more probable than not that these conditions can be related to relevant service. Section 9 lists 15 specific factors - each with a time window - that must exist before a causal connection can be found. Section 10 requires that each factor be related to the person’s relevant service, and separately addresses clinical worsening where the condition existed before or during (but did not arise out of) that service. Section 11 provides that if a factor in section 9 refers to another injury or disease that is itself covered by a different Statement of Principles, then that other instrument’s factors apply.

The instrument thus reduces a complex medical judgment to a checklist of prescribed causal pathways. It does not create any new rights or duties beyond those already in the VEA and MRCA; rather, it operationalises the statutory requirement that a decision‑maker must apply a Statement of Principles when determining claims involving a kind of injury, disease or death to which the instrument relates.

Visual refractive error: The core defined condition. It is a group of eye diseases where the eye’s optical system, when relaxed, does not focus light onto the retina because the refractive power does not match the eyeball length. The instrument includes myopia (nearsightedness), hyperopia (farsightedness, also called hypermetropia), astigmatism, and anisometropia (a significant difference between the two eyes). Presbyopia is explicitly excluded. The definition takes precedence over ICD‑10‑AM codes; those codes are informational only.

Balance of probabilities: The standard of proof used in claims under VEA section 120B and MRCA section 339. The instrument is made under VEA subsection 196B(3), which is the balance‑of‑probabilities branch of the power. (Separate instruments exist for the reasonable‑satisfaction standard under subsection 196B(2).) This SoP only applies to claims where the decision‑maker must be satisfied on the balance of probabilities - that is, more likely than not.

Factors: The enumerated events or circumstances in section 9. A claimant must establish at least one factor exists before the condition can be related to service. Each factor has a specified temporal relationship to “clinical onset” or “clinical worsening”. Factors include: acquired eyelid mass, pterygium, corneal surgery (within two years), penetrating keratoplasty (within two years), corneal scarring, keratoconus, scleral buckle surgery (within six months), tilted intraocular lens, acquired aphakia, acquired displacement of intraocular lens, nuclear cataract, cataract surgery (within six months), retinal detachment surgery (within six months), blunt or penetrating trauma to the eye (within one month), and taking any of nine named medications (within two weeks for myopia only). Factor 15 is the inability to obtain appropriate clinical management before clinical worsening.

Clinical onset and clinical worsening: These terms are not defined in the instrument, but are standard in SoP practice. “Clinical onset” refers to the first manifestation of the condition at a level that could be diagnosed. “Clinical worsening” is the material aggravation of a pre‑existing condition. Section 10(2) restricts the clinical‑worsening aspects to cases where the condition was suffered or contracted before or during service but did not arise out of that service (i.e., it was not service‑caused initially).

Relevant service: Defined in the Dictionary 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. This is significant: it excludes operational service (where a higher standard of proof applies) and hazardous service or British nuclear test defence service under the VEA. The instrument therefore only covers non‑operational, non‑hazardous service.

The instrument directly affects veterans and members of the Forces who have rendered “relevant service” as defined: eligible war service that is not operational service, defence service that is not hazardous or British nuclear test defence service, and peacetime service under the MRCA. These are the categories of service where the balance‑of‑probabilities standard applies. Operational service and hazardous service are governed by separate Statements of Principles made under the reasonable‑satisfaction power (subsection 196B(2) of the VEA) and are not covered by this instrument.

Claimants who have rendered relevant service and who develop myopia, hyperopia, astigmatism or anisometropia - or die from complications related to those conditions - will need to satisfy at least one factor in section 9 for their claim to succeed. The instrument also affects dependants who claim in respect of a veteran’s death from visual refractive error.

The primary audience is decision‑makers in the Department of Veterans’ Affairs and the Military Rehabilitation and Compensation Commission (MRCC). They must apply the instrument when determining liability and assessing compensation. Legal practitioners, advocates, and medical witnesses advising claimants must also understand the factor list, the time windows, and the interaction with other Statements of Principles.

Medical specialists - particularly ophthalmologists and optometrists - may be asked to provide reports addressing whether a factor exists, the timing of clinical onset or worsening, and whether the factor is related to service. The instrument imposes a burden on the claimant to produce evidence linking, for example, a specific medication (such as topiramate or acetazolamide) taken within two weeks of onset to service. Similarly, service‑related trauma such as a blow to the eye or a shrapnel injury would need to be documented in service records.

Because the instrument excludes presbyopia and certain surgical or pharmacological triggers are time‑limited, claimants with ordinary age‑related farsightedness are not assisted. Those whose refractive error arises solely from ageing or genetic predisposition without a listed factor will not meet the connection requirement, absent reliance on another SoP (e.g., for an underlying condition like keratoconus).

The repeal of the 2016 SoP means that any claim made on or after 25 March 2025 must be assessed under this new instrument. Claims already determined are unaffected unless reopened. The instrument applies to claims to which s120B VEA or s339 MRCA applies, so it covers both new claims and some reviews or appeals.

Duty of the Repatriation Medical Authority: To determine Statements of Principles based on sound medical‑scientific evidence. The Authority has exercised that power here, balancing the scientific evidence against the statutory standard. There is no duty to review this instrument periodically, but it may be replaced later.

Duty of the decision‑maker: Under section 120B of the VEA and section 339 of the MRCA, the decision‑maker (the Repatriation Commission or the MRCC) must apply a Statement of Principles when deciding a claim concerning a kind of injury, disease or death to which the SoP relates. This instrument defines that kind. If a factor is found to exist and is related to service, the decision‑maker must determine that the condition is connected with service (subject to any contrary evidence). If no factor exists, the claim must be refused. The decision‑maker has no discretion to invent new factors; the list in section 9 is exhaustive.

Rights of the claimant: The claimant has the right to have their claim assessed under the correct SoP, and to rely on any of the factors. They also have the right to argue that a factor is satisfied even if unusual, provided the medical evidence supports it. The instrument does not impose a duty on the claimant to prove any particular factor; they simply must satisfy one. If the condition existed before service, the claimant may still succeed on clinical‑worsening grounds, but only if the factor contributed to material aggravation after the onset of service.

Interaction with other SoPs: Section 11 creates an important procedural right: if a factor in section 9 refers to an injury or disease that is itself covered by another Statement of Principles (for example, keratoconus), then the factors in that other SoP must also be satisfied. This means a claimant relying on factor 6 (keratoconus of the affected eye) must also show that the keratoconus itself meets its own SoP factors. This can create a chain of proof obligations.

No new substantive rights: The instrument does not create any entitlement to compensation that does not already exist under the VEA or MRCA. It merely codifies the medical nexus. Similarly, it does not impose obligations on third parties (such as employers) or confer rights of action in tort.

The instrument itself does not contain penalty provisions. It is not a penal instrument; it is a legislative rule that guides administrative decision‑making. However, non‑compliance by a decision‑maker - for example, failing to apply the correct SoP or misinterpreting a factor - can lead to an incorrect decision that may be appealed to the Veterans’ Review Board or the Administrative Appeals Tribunal, and ultimately to the Federal Court on a question of law.

A decision‑maker who refuses a claim without properly considering the relevant factors faces the risk that the decision is set aside and remitted. There is no personal penalty imposed on the decision‑maker, but the department or commission may be required to pay costs in some tribunal or court proceedings.

For claimants or their representatives, there is no penalty for bringing a claim that does not meet the factors, other than the cost of time and the possibility of an adverse costs order in tribunal (rare in veterans’ jurisdiction). However, fraudulently claiming a factor - such as fabricating a history of trauma or medication use - could attract criminal penalties under the Criminal Code Act 1995 (Cth) for obtaining a financial advantage by deception or for giving false or misleading information. The instrument itself does not create those offences.

The real enforcement mechanism is the administrative filter: the decision‑maker must be satisfied on the evidence that a factor exists. Medical reports, service records, and expert opinion are scrutinised. If a factor is absent, the claim fails. The instrument thus serves as a gatekeeper for compensation payments, and its effect is to constrain the circumstances in which public funds are spent. From an economic perspective, this reduces the fiscal cost of the veterans’ compensation scheme by limiting liability to cases where the claimed condition has a scientifically accepted link to service. Conversely, it creates a compliance burden on claimants to gather evidence for what may be a relatively minor condition (e.g., myopia from short‑term medication).

Veterans’ Entitlements Act 1986: This is the primary statute. The instrument is made under subsection 196B(3). Section 120B of the VEA requires that where a Statement of Principles exists for a kind of injury, disease or death, the decision‑maker must apply it. This instrument defines “visual refractive error” as a kind of disease. It also interacts with the definitions of “relevant service” (eligible war service (non‑operational) and defence service (non‑hazardous, non‑British nuclear test)) as set out in the VEA.

Military Rehabilitation and Compensation Act 2004: Section 339 of the MRCA mirrors section 120B of the VEA, requiring application of the SoP for claims under that Act. The instrument applies to peacetime service under the MRCA. It does not apply to warlike or non‑warlike service under the MRCA (which would be covered by the reasonable‑satisfaction SoP if one exists).

Other Statements of Principles: Section 11 of this instrument incorporates by reference any other SoP that covers an injury or disease referred to in a factor. For example, factor 6 refers to keratoconus. There is a separate SoP for keratoconus (Balance of Probabilities). That SoP will have its own list of factors. A claimant relying on keratoconus as a factor for visual refractive error must also satisfy the keratoconus SoP. This creates a cascading application of SoPs, and decision‑makers must check multiple instruments.

ICD‑10‑AM: The instrument references ICD‑10‑AM codes for each subtype but makes clear that the meaning of the condition is given in subsection 7(2), not the code. This prevents reliance on a coding error to expand or contract coverage.

Repeal: The earlier SoP (No. 10 of 2016) is repealed. Claims lodged before 25 March 2025 but not yet decided may fall under the old instrument if the law so provides, but standard transitional provisions (not included in this instrument) would apply. The instrument does not contain savings or transitional clauses.

Common law: The SoP does not create any private cause of action. It operates exclusively within the veterans’ compensation framework. No third‑party rights are affected.

The instrument is new and has not been amended. It was made on 18 February 2025 and commences on 25 March 2025. It replaces the earlier Statement of Principles concerning myopia, hypermetropia and astigmatism (Balance of Probabilities No. 10 of 2016), registered as F2016L00246. That earlier instrument is repealed in its entirety.

No transitional provisions are included; the earlier instrument simply ceases to apply to claims made after commencement. The Authority did not issue an exposure draft or consultation paper for this instrument; SoPs are determined internally by the RMA based on the available medical‑scientific evidence.

There is no amendment history within this instrument itself. Future amendments could alter the list of factors, time windows, definitions, or the basis for determination. RMA practice is to update SoPs periodically as medical knowledge evolves. The 2025 version differs from the 2016 version in its definitions (now including anisometropia explicitly), its expanded list of medications (nine rather than a shorter list), and updated clinical terminology.

This instrument has been in force for only a short time (from 25 March 2025). There is no reported litigation directly concerning this instrument as of the date of this instrument. However, SoPs in general are frequently the subject of review in the Administrative Appeals Tribunal (AAT) and judicial review in the Federal Court. Common issues include: whether the Authority had a proper evidentiary basis for including or excluding a factor; whether a factor was correctly interpreted; and whether the temporal requirements were satisfied.

The earlier 2016 SoP may have been litigated, but the source does not name any specific cases. A typical example of litigation under a prior eye‑related SoP might involve the meaning of “clinical onset” or whether a particular medication was “taken” for the requisite period.

Claimants challenging a decision under this instrument will need to establish that the decision‑maker erred in law - for example, by misreading a factor, by requiring evidence beyond what is reasonable, or by failing to apply section 11 correctly. The instrument itself is not immune to challenge: the RMA’s determination of “sound medical‑scientific evidence” is reviewable on Wednesbury unreasonableness grounds, but the High Court has held that the merits of the scientific assessment are for the Authority, not the courts.

Until the instrument is tested in litigation, its interpretation is largely untested. Practitioners should expect that issues such as the interaction with presbyopia exclusion and the definition of “clinical worsening” in relation to non‑service‑aggravated pre‑existing conditions will be contested.

Exclusion of presbyopia: The instrument explicitly excludes presbyopia (age‑related farsightedness) from “visual refractive error” and from “hyperopia”. This means a veteran with ordinary age‑related reading glasses problems cannot rely on this SoP, even if symptoms overlap with hyperopia.

Operational and hazardous service not covered: The instrument only applies to claims on the balance of probabilities for non‑operational and non‑hazardous service. Veterans with operational service must use the reasonable‑satisfaction SoP (if one exists for visual refractive error). A decision‑maker may wrongly apply this instrument to an operational service claim, leading to error.

Time windows are strict: Each factor has a temporal requirement: within two years, six months, one month, or two weeks before clinical onset or clinical worsening. For example, factor 13 (surgery for retinal detachment) must occur within six months before onset; factor 14 (blunt or penetrating trauma) must occur within one month. Missing the window by even a day means the factor cannot be relied on.

“Inability to obtain appropriate clinical management” (factor 15) is vague: This factor applies only to clinical worsening, and only where the inability is before worsening. It does not define “appropriate clinical management” or what constitutes an inability. It could be interpreted narrowly (e.g., no access to an ophthalmologist) or broadly (e.g., financial barriers, waiting lists). This factor is likely to be contested.

Factor 14 (trauma) is extremely short - one month: A veteran who suffered an eye injury two months before developing myopia would not meet this factor. This is a high evidentiary bar.

Medication list (factor 13) is exclusive: Only the nine listed medications count. Other drugs known to cause myopia (e.g., some anticholinergics not listed) cannot be used under this factor. The factor also requires that the medication “cannot be ceased or substituted in the long term”, which adds a clinical judgment element.

Chain of SoPs under section 11: If a factor refers to another disease (e.g., keratoconus, pterygium, cataract), the claimant must also satisfy the factors of that other disease’s SoP. This can be burdensome and is easily overlooked.

Clinical worsening limited: The clinical worsening aspects of factors only apply where the condition was suffered or contracted before or during service but did not arise out of service. If the condition did arise out of service, the factor must relate to clinical onset, not worsening. This creates complexity for cases where service both caused and aggravated a pre‑existing condition.

For decision‑makers (Repatriation Commission, MRCC, delegates):

• Identify whether the claim falls under the balance‑of‑probabilities standard (s120B VEA or s339 MRCA). If the veteran has operational or hazardous service, do not use this instrument.
• Determine whether the claimed condition falls within the definition of visual refractive error in section 7. If it is presbyopia, reject reliance on this SoP.
• Check for each proposed factor against the evidence. The factor must exist at the correct time relative to clinical onset or clinical worsening. Record the date of clinical onset and clinical worsening.
• Ensure that the factor is related to the person’s relevant service (section 10(1)). A factor that exists but is unrelated to service (e.g., a car accident while on leave) cannot be used unless it otherwise arises out of service.
• Apply section 11: if the factor references another injury or disease (e.g., keratoconus, pterygium, cataract, trauma that caused scarring, etc.), locate and apply the relevant SoP for that condition. Do not assume the factor alone is sufficient.
• When dealing with clinical worsening, confirm that the condition was suffered or contracted before or during service but did not arise out of service (section 10(2)).
• Provide clear written reasons explaining which factor (if any) is satisfied, how it is related to service, and how any chain of SoPs was applied.

For claimants and their representatives:

• Obtain a diagnosis of visual refractive error from an ophthalmologist or optometrist, specifying whether it is myopia, hyperopia, astigmatism, or anisometropia, and expressly confirming it is not presbyopia.
• Gather evidence of any listed factor in section 9. This may include: medical records of eyelid mass, pterygium, corneal surgery, keratoconus diagnosis, cataract, trauma, medication history, or evidence that clinical management was unavailable.
• Pay close attention to the time windows. If relying on medication (factor 13), obtain pharmaceutical records showing the prescription and the date of commencement relative to the onset of refractive change. Expert opinion may be needed to establish whether the medication could be ceased or substituted long term.
• If relying on factor 15 (inability to obtain appropriate clinical management), show that the claimant was unable to access treatment (e.g., because of remote location, cost, or service‑related disability) and that this inability preceded worsening.