The Process of Review

A description of the process of review is available at the : SMRC Process of Review Information paper for applicants requesting a review by the SMRC under section 196Y (PDF 256) (RTF 1.2 MB). This information is summarised in the sections below.

What information is reviewed by the SMRC?

The Specialist Medical Review Council reviews all of the information that was before the Repatriation Medical Authority when it made the decision that is being reviewed by the Specialist Medical Review Council.

The information that was before the Repatriation Medical Authority is the only information the Specialist Medical Review Council can review.

If there is new information presented to the Specialist Medical Review Council, or of which the Specialist Medical Review Council is aware, it is possible for the Specialist Medical Review Council to bring this to the Repatriation Medical Authority’s attention when the Specialist Medical Review Council writes its decision.

The Specialist Medical Review Council cannot, however, use new information to direct the Repatriation Medical Authority to amend a Statement of Principles that is under review.

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How does the SMRC carry out a review?

In conducting a review the Specialist Medical Review Council follows a two step process.  It first determines the body of sound medical-scientific evidence that is relevant to whether or not a particular kind of injury, disease or death can be related to service.

Section 5AB(2) of the Veterans’ Entitlements Act 1986  defines sound medical-scientific evidence about a particular kind of injury as that information that:

  • is consistent with material relating to medical science that has been published in a medical or scientific publication and has been, in the opinion of the Repatriation Medical Authority, subjected to a peer review process; or
  • in accordance with generally accepted medical practice, would serve as the basis for the diagnosis and management of a medical condition; and
  • in the case of information about how that kind of injury, disease or death m may be caused – meets the applicable criteria  for assessing causation currently applied in the field of epidemiology.

In the second step, the Specialist Medical Review Council considers whether there is sound medical-scientific evidence (in respect of the factors, which the Specialist Medical Review Council has decided are within the scope of its review) that indicates that:

  • the particular kind of injury, disease or death can be related to operational service, or peacekeeping service, or hazardous service ie, the ‘reasonable hypothesis test; and/or
  • it is more probable than not that the particular kind of injury, disease or death can be related to eligible war service (other that operational service) or defence service (other that hazardous service) ie, the balance of probability test.

The ‘reasonable hypothesis’ test requires the Specialist Medical Review Council to exercise its expertise and judgement in deciding whether the sound medical-scientific evidence points to, as opposed to merely leaving open, the possibility of an association between the disease and operational service.

The ‘balance of probabilities’ test requires the Specialist Medical Review Council to exercise its expertise and judgement in deciding whether any association is more probable than not.  This is a harder test to satisfy than that of reasonable hypothesis.

The Specialist Medical Review Council provides written reasons for its decision, which include:

  • the background to the application and review,
  • a summary of the contentions of the Applicant
  • a summary of the contentions of any other person or organisation which makes a submission to the Specialist Medical Review Council,
  • an analysis of the pool of information,
  • its decision, and
  • as appendices, lists of the information.

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How is a submission made to the SMRC?

The Specialist Medical Review Council’s notice in the Government Gazette of its intention to carry out a review states the date by which written submissions must be received by the Specialist Medical Review Council.  Eligible persons or organisations (see ‘Who can apply for a review by the SMRC?’) and persons having expertise in a field relevant to the review may make a written submission about any information that was available to the Repatriation Medical Authority (and is therefore sent by the RMA to the SMRC) and is relevant to the review.

Those who make a written submission may make a complementary oral submission.

Submissions can not be made on a legal matter.

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What can the SMRC decide?

The Specialist Medical Review Council cannot make or amend a Statement of Principles. 

If the Specialist Medical Review Council considers that there is sound medical-scientific evidence that the Repatriation Medical Authority could have relied on to amend or to determine a Statement of Principles it:

  • directs the Repatriation Medical Authority to amend the Statement of Principles or determine a Statement of Principles in accordance with the Specialist Medical Review Council’s directions; or
  • remit the matter to the Repatriation Medical Authority for reconsideration in accordance with any directions or recommendations the Specialist Medical Review Council might make.

Such a declaration may also include any recommendation that the Specialist Medical Review Council considers appropriate about any future investigation that the Repatriation Medical Authority may carry out in respect of the particular kind of injury, disease or death.

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How does the SMRC reach a decision?

The Specialist Medical Review Council reaches a decision on a matter under review by a majority of the votes of the Councillors who conducted the review.  The Convener or Presiding Councillor has only a deliberative vote.

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