{"id":"F2024L01338","name":"Statement of Principles concerning Achilles tendinopathy (Balance of Probabilities) (No. 87 of 2024)","slug":"statement-of-principles-concerning-achilles-tendinopathy-balance-of-probabilities-no-87-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442624,"registerId":"F2024L01338-fast-fetch-1775957589992","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning Achilles tendinopathy (Balance of Probabilities) (No. 87 of 2024)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nACHILLES TENDINOPATHY  (Balance of Probabilities)\n\n(No. 87 of 2024)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 18 October 2024.\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\n\n \n\n   \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Repeal\n\n5 Application\n\n6 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n \n\n\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning Achilles tendinopathy (Balance of Probabilities) (No. 87 of 2024).\n\n1.                Commencement\n\n\n              This instrument commences on 19 November 2024.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning Achilles tendinopathy and bursitis (Balance of Probabilities) (No. 97 of 2015) (Federal Register of Legislation No. F2015L01337) made under subsection 196B(3) of the VEA is repealed.\n\n1.                Application\n\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about Achilles tendinopathy and death from Achilles tendinopathy.\n\n\nMeaning of Achilles tendinopathy\n\n1.           For the purposes of this Statement of Principles, Achilles tendinopathy:\n  1.           means a symptomatic inflammatory or degenerative disease of the Achilles tendon or paratendon; and\n  2.           includes:\n    1.             insertional tendinopathy of the Achilles tendon;\n    2.          mid portion tendinopathy of the Achilles tendon;\n    3.        degenerative tears of the Achilles tendon; and\n    4.         Achilles enthesopathy or enthesitis.\n\n\nNote: Achilles tendinopathy is also known as Achilles tendonitis or paratendonitis, Achilles tendinosis or paratendinosis. Insertional Achilles tendinopathy is less than 2 cm proximal to the calcaneus and is a separate disease from Achilles enthesopathy, and mid portion Achilles tendinopathy is 2-7 cm proximal to the calcaneal insertion.  \n\nDeath from Achilles tendinopathy\n\n1.           For the purposes of this Statement of Principles, Achilles tendinopathy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's Achilles tendinopathy.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that Achilles tendinopathy and death from Achilles tendinopathy can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.\n\n1.                Factors that must exist\n\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, Achilles tendinopathy or death from Achilles tendinopathy is connected with the circumstances of a person's relevant service:\n\n1.           running or jogging an average of at least 60 kilometres per week for the 4 weeks before clinical onset or clinical worsening;\n2.           undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side for:\n  1.           a minimum intensity of 5 METS; and\n  2.           for at least 6 hours per week; and\n  3.           for at least the 4 weeks before clinical onset or clinical worsening;\n\n\nNote 1: Examples of weight bearing exercise involving repeated activity of the ankle joint at a minimum intensity of 5 METS include marching, playing basketball, football, volleyball, and track and field (especially those activities that involve jumping).\n\nNote 2: MET (metabolic equivalent) is a unit of measure of the level of physical capability of the cardiorespiratory system. For example, 1 MET = cardiorespiratory effort associated with a person sitting, 3-4 METs = cardiorespiratory effort associated with a person walking at average walking pace (5 km/h) or light gardening.\n\n1.           increasing the frequency, duration or intensity of activity involving the ankle joint on the affected side:\n  1.           by at least 100 percent; and\n  2.           to a minimum intensity of 5 METs; and\n  3.           for at least 4 hours per day;\n\n\nwithin the 1 week before the clinical onset or clinical worsening;\n\nNote: MET (metabolic equivalent) is a unit of measure of the level of physical capability of the cardiorespiratory system. For example, 1 MET = cardiorespiratory effort associated with a person sitting, 3-4 METs = cardiorespiratory effort associated with a person walking at average walking pace (5 km/h) or light gardening.\n\n1.           having one or more of the following conditions involving the affected lower limb at the time of clinical onset or clinical worsening:\n  1.           decreased ankle or forefoot flexibility;\n  2.           forefoot varus;\n2.           having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening:\n  1.           ankylosing spondylitis;\n  2.           Behcet syndrome;\n  3.           enteropathic spondyloarthropathy (arthritis associated with inflammatory bowel disease);\n  4.           gout;\n  5.           pseudogout (calcium pyrophosphate dihydrate) or crystal-induced arthropathy from the deposition of calcium hydroxyapatite or calcium oxalate;\n  6.            psoriatic arthropathy\n  7.           reactive arthritis;\n  8.           rheumatoid arthritis; or\n  9.             undifferentiated spondyloarthropathy;\n3.           being treated with a fluoroquinolone antibiotic within the 30 days before clinical onset or clinical worsening;\n\n\nNote: Examples of fluoroquinolone antibiotics include ciprofloxacin, moxifloxacin, norfloxacin and ofloxacin.\n\n1.           being treated with a glucocorticoid drug as specified before clinical onset or clinical worsening;\n\n\nNote: being treated with a glucocorticoid drug as specified is defined in the Schedule 1 - Dictionary.\n\n1.           having a glucocorticoid injection into the Achilles tendon, in the region of the Achilles tendon or in the retrocalcaneal bursa, before the rupture of the Achilles tendon;\n\n\nNote: rupture of the Achilles tendon can constitute clinical onset or clinical worsening of Achilles tendinopathy.\n\n1.           being treated with an aromatase inhibitor for at least 4 weeks within the 1 year before clinical onset or clinical worsening;\n\n\nNote: Examples of aromatase inhibitors include anastrozole, exemestane and letrozole.\n\n1.       having a Body Mass Index (BMI) of 30 or greater at the time of clinical onset or clinical worsening;\n\n\nNote: BMI is defined in the Schedule 1 – Dictionary.\n\n1.       having diabetes mellitus at the time of clinical onset or clinical worsening;\n2.       inability to obtain appropriate clinical management for Achilles tendinopathy before clinical worsening.\n\n\n1.            Relationship to service\n  1.           The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.\n  2.           The clinical worsening aspects of factors set out in section 9 apply only to material contribution to, or aggravation of, Achilles tendinopathy where the person's Achilles tendinopathy was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 9 applies in relation to a person; and\n2.           that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA;\n\n\nthen the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.\n\n \n\n \n\nSchedule 1 - Dictionary  \n\nNote:               See Section 6\n\n1               Definitions\n\nIn this instrument:\n\n                             achilles tendinopathy—see subsection 7(2).\n\n                               being treated with a glucocorticoid drug as specified means:\n\n(a)          being treated with prednisolone, in the combinations of mode of administration, dose, duration of treatment and proximity to the clinical onset or worsening of Achilles tendinopathy, as specified in Table 1 below; or\n\n(b)          being treated as specified in Table 1 with a glucocorticoid drug other than prednisolone in doses having an efficacy equivalent to prednisolone, that being calculated for the drugs listed in accordance with Table 2 below.\n\n \n\nTable 1\n\n- Drug or Class of Drugs Mode* Dose Minimum Duration of Treatment Duration\n- prednisolone orpharmacologically equivalent glucocorticoid IV, IM, O  0.5 grams over 6 months 6 months within the 3 years\n-  3 grams NS within the 5 years\n-  10 grams NS NS\n\n\nAbbreviations: IV = intravenous; IM = intramuscular; O = oral; NS = not specified.\n\nTable 2\n\n| Glucocorticoid | Dose ratio equivalence with respect to prednisolone |\n| --- | --- |\n| cortisone | 5 |\n| hydrocortisone | 4 |\n| prednisolone | 1 |\n| prednisone | 1 |\n| methylprednisolone | 0.8 |\n| triamcinolone | 0.8 |\n| paramethasone | 0.4 |\n| dexamethasone | 0.15 |\n| betamethasone | 0.12 |\n\n\n \n\n                               BMI means W/H2 where:\n\n(a)          W is the person's weight in kilograms; and\n\n(b)          H is the person's height in metres.\n\n                             MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n                             relevant service means:\n\n(a)          eligible war service (other than operational service) under the VEA;\n\n(b)          defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c)          peacetime service under the MRCA.\n\nNote: MRCA and VEA are defined in the Schedule 1 - Dictionary.\n\n                             terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a)           pneumonia;\n\n(b)           respiratory failure;\n\n(c)           cardiac arrest;\n\n(d)           circulatory failure; or\n\n(e)           cessation of brain function.\n\n                             VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2015 Statement concerning Achilles tendinopathy and bursitis (section 4) and replaces it with a Statement focused on Achilles tendinopathy (including subtypes) and death from it. The new instrument narrows the titular scope by omitting 'bursitis' and introduces specific measurable triggers (exercise thresholds, drug/treatment dose‑time criteria, BMI, diabetes, inability to obtain care) and cross-references to other Statements, altering the conditions under which service connection will be accepted (sections 7–11; Schedule 1)."},"complexity_factors":["Multiple quantitative exposure thresholds for physical activity (running km/week; METs; hours/week; sudden increase percentages) creating detailed evidentiary requirements (section 9.1–9.3).","Pharmacological and procedural triggers with timing and dose windows (fluoroquinolones, glucocorticoid systemic dosing, local glucocorticoid injections, aromatase inhibitors) requiring clinical records for proof (sections 9.4–9.7; Schedule 1 Table 1–2).","Detailed list of systemic arthritic diseases that individually qualify as factors, raising diagnostic-record complexity (section 9.3.2).","Technical measures and definitions (BMI formula, METs, terminal event) encoded in Schedule 1 and notes, requiring expert interpretation (Schedule 1; notes to sections).","Distinction between clinical onset and clinical worsening, and requirement that factors be 'related to relevant service'—adds causal-link complexity and temporal constraints (section 10).","Cross-reference mechanism to other Statements of Principles so overlapping injuries/diseases defer to other SOPs (section 11), increasing inter-instrument dependence.","Repeal of the prior 2015 instrument and narrower titular focus (bursitis removed) changes prior coverage and evidential baseline (section 4; heading and preamble).","Some entries in dosing table are 'not specified' (NS), creating interpretive discretion for dose/duration in particular cases (Schedule 1 Table 1).","Application limited to VEA/MRCA claims—procedural and jurisdictional scope is narrow but concentrated on veteran claim processes (section 5).","Potential claimant burden to document precise exercise levels, drug dosages/timings, BMI and access-to-care failures to meet thresholds (sections 9 & Schedule 1)."],"plain_english_summary":"This Statement of Principles sets the medical criteria the Repatriation Medical Authority will use to decide whether Achilles tendinopathy (and death contributed by it) is connected to veterans’ or defence service for VEA/MRCA claims. It repeals the 2015 Statement on Achilles tendinopathy and bursitis and replaces it with measurable triggers—exercise load, treatment exposures (specific antibiotics, glucocorticoid dosing, aromatase inhibitors), BMI, diabetes and access-to-care—that must be present and service‑related before entitlement is accepted."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":5,"scope_assessment":{"changed":true,"description":"The original 2015 instrument covered both 'Achilles tendinopathy AND bursitis' — this 2024 version narrows scope to focus solely on Achilles tendinopathy, removing bursitis from coverage. This represents a deliberate restriction rather than expansion, likely reflecting evolving medical understanding that these are distinct conditions requiring separate evidentiary standards."},"complexity_factors":["Multiple nested subsections with alphanumeric numbering (9(1)(a)(i) style)","13 distinct factors with varying specificity — some require precise measurements (60km/week, 5 METS, BMI 30+)","Technical medical terminology requiring definitions (METS, forefoot varus, enthesopathy, fluoroquinolone)","Cross-referenced definitions in Schedule 1 including mathematical formulas (BMI calculation) and pharmacological equivalence tables","Conditional logic for clinical worsening versus clinical onset in section 10","Interaction clause in section 11 requiring reference to other Statements of Principles","Specific temporal requirements (4 weeks before, 30 days before, 1 year before, 3 years, 5 years)"],"plain_english_summary":"This instrument replaces the 2015 rule to focus solely on Achilles tendinopathy, specifying 13 medical and activity-related factors and using the \"balance of probabilities\" test to decide if the condition was caused or aggravated by military service. It applies to veterans under the Veterans' Entitlements Act 1986 and current/former defence members under the Military Rehabilitation and Compensation Act 2004.\n\nIt matters because it determines entitlement to medical care and compensation, guiding clinicians and decision-makers in linking heel/ankle pain to service."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-achilles-tendinopathy-balance-of-probabilities-no-87-of-2024","history":"/api/acts/statement-of-principles-concerning-achilles-tendinopathy-balance-of-probabilities-no-87-of-2024/history","analysis":"/api/acts/statement-of-principles-concerning-achilles-tendinopathy-balance-of-probabilities-no-87-of-2024/analysis","conflicts":"/api/acts/statement-of-principles-concerning-achilles-tendinopathy-balance-of-probabilities-no-87-of-2024/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-achilles-tendinopathy-balance-of-probabilities-no-87-of-2024/important-cases","documents":"/api/acts/statement-of-principles-concerning-achilles-tendinopathy-balance-of-probabilities-no-87-of-2024/documents"}}