FAQs

FAQs

These Frequently Asked Questions (FAQs) are designed to provide a better understanding of the Repatriation Medical Authority (RMA) and the Statements of Principles (SOPs) produced by the RMA. They provide basic information, sometimes about fairly complex topics, and will sometimes link to more detailed information.

The Authority does not provide legal advice. This FAQ page is for informational purposes and is not a substitute for legal advice. It may not cover important issues that affect you. You should consult with your legal adviser if you have questions. Have a question that isn't answered here? Contact us


Why are there two SOPs for each medical condition?

The legislation provides that claims for pension (and the SOPs used to determine claims) should be assessed at two different standards of proof. The more generous (beneficial) standard, known as the reasonable hypothesis standard, applies to veterans and serving members who have operational (or equivalent) service. This includes peacekeeping, hazardous and British nuclear test defence service under the Veterans’ Entitlements Act 1986 (the VEA), and warlike and non-warlike service under the Military Rehabilitation and Compensation Act 2004 (the MRCA). The balance of probabilities standard is for veterans and serving members with non-operational service.

Therefore, for any given condition there are two SOPs. In most cases there are at least slight differences, and in many cases the more generous reasonable hypothesis version of the SOP will contain more causal factors.

The legislation requires that the same body of evidence be interpreted differently for the two standards of proof. For the reasonable hypothesis standard, the sound medical-scientific evidence must indicate or point to a causal association between a risk factor and the disease in question. For the balance of probabilities standard the sound medical-scientific evidence must show that it is more probable than not that there is a causal association between a risk factor and the disease.

The definition of each type of service is listed in the definition section of each SOP under "relevant service". Claimants use the SOP that corresponds with the type of service they have rendered.

Some people will have both types of service. The appropriate SOP to use will depend upon exactly when the exposure or event (factor) was experienced on service.

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What differences are there between the two SOPs?

When the two standards of proof are applied to the same body of sound medical-scientific evidence (SMSE) by the RMA, it is often the case that the two SOPs determined for the condition are different.  The definition of the condition (i.e. the exact nature of the injury or disease which is covered by the SOP) will always be exactly the same.

The two SOPs can differ in a number of ways:

  • a number of possible factors (or causes) may be only included in the more generous reasonable hypothesis version of the SOP;

  • if a factor is included in both versions of a SOP, the ‘dose’ or level and extent of the exposure is often different. For example, this difference could be the number of cigarettes required to be smoked, the number of hours or days an activity is required to be undertaken, the minimum period of exposure to a particular chemical or substance, or the range of chemicals or drugs which may be specified;

  • factors sometimes require the clinical onset of a condition to occur a maximum (or minimum) period of time after the exposure – this is known as latency – and can differ between the two standards of proof. For example, in a number of SoPs for cancer the latency period between exposure and onset of the cancer is 5 years in the reasonable hypothesis SoP and 10 years in the balance of probabilities SoP.

Where a factor is included in both SOPs, the factor is usually more generous in the reasonable hypothesis version of the SOP. If not more generous, the wording of the factor will be the same in both SOPs.

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Which SOP applies to my claim?

The definition of each type of service is listed in the Schedule 1 – Dictionary contained in each SOP under the term "relevant service". You should use the SOP which corresponds to the type of service you have rendered.

Some people will have both types of service. The appropriate SOP to use will depend upon exactly when the exposure or event (factor) was experienced during service, and what kind of service was being undertaken at the time.

Some factors require a ‘dose’ of exposure to an agent or activity (for example, lifting a certain amount of weight within a certain period; a cumulative number of flying hours, or smoking a cumulative number of cigarettes). In some cases the ‘dose’ can only be met by combining the exposure experienced in different periods and types of service.

In those circumstances, if the combination of exposure experienced during operational and non-operational service exposure meets the minimum requirement specified in the balance of probabilities SOP, the claim is likely to succeed.

If not, if the combination of operational and non-operational service exposure meets the minimum requirement specified in the reasonable hypothesis SOP, and the operational service contribution is considered to be ‘a material contribution’ (as clarified by the Federal Court decisions of Kattenberg [Kattenberg v Repatriation Commission [2002] FCA 412] and Bendy [Repatriation Commission v Richard Edward Bendy [1989] FCA 170), the claim is likely to succeed.

Further information in relation to this issue can be obtained from the Department of Veterans’ Affairs via email (GeneralEnquiries@dva.gov.au) or telephone (133 254).

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Are the SOPs legally binding?

Yes. The SOPs determined by the RMA are legislative instruments, and unless ‘disallowed’ by Parliament have the same legal effect as any legislation passed by Parliament. SOPs are binding on determining authorities at all levels (i.e. the Repatriation Commission and the Military Rehabilitation and Compensation Commission and their delegates, Veterans’ Review Board and Administrative Appeals Tribunal), including the courts.

SOPs exclusively state what factors must exist to establish a causal connection between particular diseases, injuries or death and service.

The SOPs apply to claims made under both the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). In the case of the MRCA, in some (very limited) circumstances SOPs do not apply. These include claims relating to temporary aggravation or temporary contribution to a sign or symptom of an injury or disease (section 30) and claims relating to an injury or disease arising from the unintended consequences of treatment provided by the Commonwealth (section 29).

Apart from the exceptions referred to above, all claims relating to an injury, disease or death under the VEA and the MRCA must be assessed by reference to the relevant SOP (where such a SOP exists, having regard to the definition in clause 3 which defines the condition covered). A claim must comply with (or ‘fit’) a factor contained within the relevant SOP in order for it to be accepted.

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How do I know what is meant by a term used in a SOP? Can you give me a definition if I contact you?

Definitions of many terms used in a SOP are often contained in the SOP. A definition of what exactly is meant by the name of the injury or disease is contained in clause 3 of every SOP under the heading ‘Kind of injury, disease or death’. Many of the terms used in the factors listed in a SOP are also defined, in Schedule 1 of every SOP* under the heading ‘Dictionary’. The terms (or phrases) defined are listed in alphabetical order.

If there is no definition within a particular SOP, then the ordinary meaning found in a relevant technical (usually medical) dictionary may be used, or a general dictionary. In some cases, the courts have provided guidance on how to interpret the meaning of a word or expression, which is then binding on decision-makers. An example of this is the guidance given by a range of AAT and Federal Court cases discussing the interpretation of the term ‘clinical onset’ (which includes Re Robertson and Repatriation Commission (1998), Repatriation Commission v Cornelius (2002), Lees v Repatriation Commission (2002) (FCAFC) and Repatriation Commission v Gosewinckel (1999).

The interpretation of a term used in a SOP is a matter for the decision-maker, where no definition is included and where no judicial guidance is available. If you believe that a term has not been interpreted as it should be, a review of the decision (and interpretation) can be sought by an appeal body or court. It is generally not appropriate for the RMA to indicate what it meant a term to mean. However, if the RMA is of the opinion that an interpretation is being applied which is not consistent with its intention or the medical-science on which it relied, it has the power to amend a SOP.

* note that in some older SOPs determined pre-2015 definition of words or terms are set out in clause 9 of each SOP under the heading ‘Other definitions’.

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I have a disease that is not covered by a SOP. Can I still make a claim?

Claims concerning diseases and injuries that are not covered by SOPs can still be lodged with and determined by the Department of Veterans’ Affairs, but are determined by having regard to available medical opinions and evidence rather than a SOP. Opinions may vary, and the decision-maker is required in such cases to reach a conclusion about the causal relationship of the condition with service on the basis of all of the available relevant evidence.

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Why aren’t worsening factors easier than the causal (onset) factors?

It is often the situation that there is very little (if any) medical-scientific study in relation to the aggravation or worsening of injuries or diseases. Where the RMA believes that there is a reasonable hypothesis (or it is more likely than not) that a factor that causes a disease will make it worse – whether on the basis of medical-scientific studies or clinical knowledge – unless there is clear evidence to support a lower ‘dose’ its practice is to use the same dose as for the causal (onset) factor. This is because the RMA tends to set the causal dose as low as possible consistent with the evidence available to it, and cannot reduce the dose any further without a clear scientific basis.

It is not necessarily the case that further exposure will cause further injury or worse disease because the human body has adaptive mechanisms that respond to exposure to chemicals or to physical stresses. For example, bones and cartilage are structured in such a way that they maintain their strength with usage.

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What influence do the findings of health studies of veterans have on the Authority?

Where there are data available from studies of military personnel (or veterans), these are certainly taken into account. However, whilst the amount of medical-scientific literature available is ever increasing, there are not many military studies available and studies are often of relatively small numbers of subjects, reducing the ability to identify uncommon outcomes.

Another common limitation of military studies is that they often have little or no assessment of exposures, so it is not possible to determine the specific cause of any increased rates of disease. Where exposures have been measured, assessment is often done retrospectively (after return from deployments). Information obtained retrospectively and without objective verification can be subject to inaccuracies. Therefore, information on exposures can often only be identified from well-designed studies of civilians.

A large proportion of the epidemiology about the causation of disease is derived from such studies of civilians. Studies which are often of particular importance are prospective occupational studies, where levels of exposure can be quantified with a high level of precision. Where military studies are available, the RMA obtains and considers the findings. If those studies are large, well-designed and reliable, a great deal of weight will be attached to their findings.

It is interesting to note that the sound medical-scientific evidence (SMSE) relied upon to include some of the causal factors in SOPs which are commonly associated with military experiences –such as exposure to dioxins in Vietnam, atomic radiation or benzene - were actually based to a large extent on health studies of civilian or occupational groups. Such studies include agricultural and forestry workers (applying pesticides), residents in the vicinity of Hiroshima, Nagasaki and Chernobyl (radiation exposure) and chemical and petroleum industry workers (benzene exposure).

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My treating doctor/specialist says my disease is caused by my service. S/he understands my condition best – how can the RMA ignore a specialist opinion?

Treating clinicians are usually the best placed to understand a veteran’s condition, and in most cases their opinions in relation to individual claims for pension are accepted. Decisions about the appropriate diagnosis of a condition, the likely date of clinical onset and the level of impairment, which have to be made by the Repatriation Commission or other decision-makers, usually rely upon reports and opinions of a treating doctor or specialist.

The RMA however does not deal with individual claims, but determines SOPs which set out all of the potential causes (factors) that can cause or worsen a particular injury, disease or death – at least one of which must as a minimum exist to establish a causal connection for the condition with the circumstances of an individual’s service. In making decisions about the various causes of an injury or disease, the RMA can only take in to account “sound medical-scientific evidence” (SMSE) as defined in the Veterans’ Entitlements Act 1986 (VEA). If your treating doctor or specialist is of the opinion that your disease is caused by a factor which is not included in the relevant SOP, the RMA can certainly consider the published study – or other evidence - which led to the doctor being of that opinion.

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How does the RMA deal with injuries and diseases specific to female veterans?

There are a number of different ways in which the RMA has addressed diseases and injuries experienced by female serving members and veterans.

Some SOPs are specific to injuries or diseases which only (or largely) affect females. Examples include:

Some SOPs concern injuries or diseases where females are at increased risk. Some examples include:

Some factors contained in SOPs relate to risk factors which are specific to females, including oral contraception, hormone replacement therapy, oestrogen therapy, reproductive factors, pregnancy, childbirth and the puerperium.

Where the evidence allows, different doses in factors may be specified for females. A distinction between doses for males and females is often difficult to quantify due to lack of studies which specifically measure exposures in females. The RMA has been able to make a lower dose for alcohol consumption in relation to a number of SOPs. It has also been recognised that measures of overweight and obesity are different in males and females. However evidence concerning different quantities of load bearing in females compared to males in relation to musculoskeletal conditions is currently not sufficient in quality and quantity to enable different minimum loads to be prescribed by gender.

You can read in more detail about these issues in the 'Risk factors and SOPs concerning female veterans' (pdf-21KB) (doc-47KB) document.

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I have often noticed that Defence Occupational Health and Safety (OH&S) rules and exposure standards are much lower than the levels specified in SOPs (or not even included at all). If something is recognised as dangerous, how can the RMA ignore that?

OH&S rules and standards are based upon what is known as the ‘precautionary principle’, and are usually set at a level regarded as sufficiently safe that no worker, even exposed day after day for a working lifetime, would suffer an adverse health effect, even of a temporary nature. They identify the highest dose that has not caused the most sensitive effect, and then build in safety factors of at least 10. The safety factor allows for such things as interspecies extrapolation, human variability in responses, variations in study durations, elimination half lives and absorption efficiency by different routes of exposure. The rules and standards are designed to protect workers from any adverse health effects and not necessarily a specific injury or disease.

When the RMA is considering what the minimum ‘dose’ level required to connect the injury or disease with a person’s military service, it identifies the published medical-scientific studies relating to the particular injury or disease and then specifies dose levels at the lowest level at which studies have shown exposed subjects developing the injury or disease. In most cases this will be at much higher levels than the OH&S standard.

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