Lodge an online request for an Investigation/Review Fields marked with an asterisk (*) are required. This form should be completed by a person or organisation wanting the Repatriation Medical Authority (the Authority) to: carry out an investigation in respect of a particular kind of injury, disease or death with a view to make a Statement of Principles; or review a decision not to make a Statement of Principles; or review some or all of the contents of a current Statement of Principles If you wish to request a review of a number of conditions, you need to lodge a separate request for each condition attaching or citing the information relevant to that request. It is recommended that you read the Repatriation Medical Authority's Information sheet for Applicants requesting an Investigation/Review. Your details Name of person making the request Position of person making the request (if applicable) Name of organisation on behalf of whom the request is made (if applicable) I make this request as: a person eligible to make a claim for pension under Part II or Part IV of the Veterans' Entitlements Act 1986 (the VEA); a person eligible to make a claim for compensation under section 319 of the Military Rehabilitation and Compensation Act 2004 (the MRCA); on behalf of an organisation representing veterans, Australian mariners, members of the forces, members of Peacekeeping Forces, members within the meaning of the MRCA, or their dependants; the Repatriation Commission or the Military Rehabilitation and Compensation Commission. I authorise the release of any information to the Authority required to establish my eligibility to make this request. Your address for correspondence Street Suburb State Postcode Telephone (business hours) Telephone (after hours) Email address I request that the Authority: 1. Carry out an investigation into a particular kind of injury, disease or death with a view to make a Statement of Principles concerning: 2. Review some or all of the contents of a Statement of Principles concerning: 3. Review the decision of the Authority NOT to make a Statement of Principles concerning: Date of Authority decision Statement of Principles number(s) Additional information [NB. A separate form must be completed for each condition sought to be reviewed] In the space provided below, please supply any information which you consider is related to your request. Additional pages may be attached if the space below is insufficient. Should you be requesting the Authority to review the contents of a Statement of Principles, please identify which causal factor(s) you wish to have reviewed or considered for inclusion. You should specify any peer-reviewed published information which supports your request. Attachments Attach any documents relevant to your request using the fields below (.doc, .docx or .pdf). Attachment 1 Choose file Attachment 2 Choose file Attachment 3 Choose file Disclosure of information Under section 196K of the VEA, certain decisions made by the Authority are reviewable by the Specialist Medical Review Council (SMRC). If a valid application for review by the SMRC is made, the VEA requires the Authority to disclose to the SMRC all information relevant to its determination or decision. This includes applications for investigation or review, and submissions received relevant to the matter being review by the SMRC. I have read and understood the above disclosure of information statement. I have read the RMA Submission Guidelines and understand what is 'sound medical-scientific evidence' (SMSE) which can be used by the RMA to make or amend a SOP. I have included information relating to my request which is supportive of the investigation/review requested. Once you have completed your submission, the information will be available in a PDF format for you to save (or print out) for your records.
