{"id":"F2018L01836","name":"Statement of Principles concerning chondromalacia patella (Balance of Probabilities) (No. 2 of 2019)","slug":"statement-of-principles-concerning-chondromalacia-patella-balance-of-probabilities-no-2-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439890,"registerId":"F2018L01836-fast-fetch-1775955738093","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning chondromalacia patella (Balance of Probabilities) (No. 2 of 2019)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nCHONDROMALACIA PATELLA (Balance of Probabilities)\n\n(No. 2 of 2019)\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 21 December 2018\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
|\n| --- |\n| 
Professor Nicholas Saunders AO
Chairperson
|\n\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\n1 Name\n\nThis is the Statement of Principles concerning chondromalacia patella (Balance of Probabilities) (No. 2 of 2019).\n\n2 Commencement\n\n This instrument commences on 28 January 2019.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning chondromalacia patella No. 80 of 2010 (Federal Register of Legislation No. F2010L02319) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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\n6 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about chondromalacia patella and death from chondromalacia patella.\n\nMeaning of chondromalacia patella\n\n(2) For the purposes of this Statement of Principles, chondromalacia patella:\n\n(a) means softening, fibrillation or erosion of the articular cartilage of the patella associated with recurrent or chronic patellofemoral pain; and\n\n(b) excludes osteoarthritis of the patellofemoral joint.\n\n(3) While chondromalacia patella attracts ICD‑10‑AM code M22.4, in applying this Statement of Principles the meaning of chondromalacia patella is that given in subsection (2).\n\n(4) For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.\n\nDeath from chondromalacia patella\n\n(5) For the purposes of this Statement of Principles, chondromalacia patella, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's chondromalacia patella.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n8 Basis for determining the factors\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that chondromalacia patella and death from chondromalacia patella 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\n9 Factors that must exist\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, chondromalacia patella or death from chondromalacia patella is connected with the circumstances of a person's relevant service:\n\n(1) having direct trauma to the patella of the affected knee within the three months before the clinical onset of chondromalacia patella;\n\nNote: direct trauma to the patella is defined in the Schedule 1 - Dictionary.\n\n(2) having patellar dislocation of the affected knee within the three months before the clinical onset of chondromalacia patella;\n\n(3) having an injury to the affected knee resulting in acute meniscal or ligamentous tear of the knee or permanent ligamentous instability, within the six months before the clinical onset of chondromalacia patella;\n\n(4) having acquired abnormal tracking of the patella of the affected knee for at least the three months before the clinical onset of chondromalacia patella;\n\nNote: abnormal tracking of the patella is defined in the Schedule 1 - Dictionary.\n\n(5) running or jogging an average of at least 60 kilometres per week for at least the four weeks before the clinical onset of chondromalacia patella;\n\n(6) undertaking weight bearing exercise involving forceful loading of the affected patellofemoral joint, at a minimum intensity of five METs for at least six hours per week, for at least the four weeks before the clinical onset of chondromalacia patella;\n\nNote: MET is defined in the Schedule 1 - Dictionary. \n\n(7) increasing the frequency, duration or intensity of weight bearing activity involving the affected knee by at least 100 percent, to a minimum intensity of five METs for at least four hours per day, for at least the seven days before the clinical onset of chondromalacia patella;\n\nNote: MET is defined in the Schedule 1 - Dictionary. \n\n(8) having direct trauma to the patella of the affected knee within the three months before the clinical worsening of chondromalacia patella;\n\nNote: direct trauma to the patella is defined in the Schedule 1 - Dictionary.\n\n(9) having patellar dislocation of the affected knee within the three months before the clinical worsening of chondromalacia patella;\n\n(10) having an injury to the affected knee resulting in acute meniscal or ligamentous tear of the knee or permanent ligamentous instability, within the six months before the clinical worsening of chondromalacia patella;\n\n(11) having acquired abnormal tracking of the patella of the affected knee for at least the three months before the clinical worsening of chondromalacia patella;\n\nNote: abnormal tracking of the patella is defined in the Schedule 1 - Dictionary.\n\n(12) running or jogging an average of at least 60 kilometres per week for at least the four weeks before the clinical worsening of chondromalacia patella;\n\n(13) undertaking weight bearing exercise involving forceful loading of the affected patellofemoral joint, at a minimum intensity of five METs for at least six hours per week, for at least the four weeks before the clinical worsening of chondromalacia patella;\n\nNote: MET is defined in the Schedule 1 - Dictionary. \n\n(14) increasing the frequency, duration or intensity of weight bearing activity involving the affected knee by at least 100 percent, to a minimum intensity of five METs for at least four hours per day, for at least the seven days before the clinical worsening of chondromalacia patella;\n\nNote: MET is defined in the Schedule 1 - Dictionary. \n\n(15) inability to obtain appropriate clinical management for chondromalacia patella.\n\n10 Relationship to service\n\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\n(2) The factors set out in subsections 9(8) to 9(15) apply only to material contribution to, or aggravation of, chondromalacia patella where the person's chondromalacia patella was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1) if a factor referred to in section 9 applies in relation to a person; and\n\n(2) 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\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 abnormal tracking of the patella means aberrant movement or positioning of the patella relative to the femoral condyles in the course of knee flexion or extension.\n\n chondromalacia patella—see subsection 7(2).\n\n direct trauma to the patella means a blow to the kneecap causing immediate patellar pain that persists for at least 24 hours.\n\n MET means a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute, 1.0 kcal/kg of body weight per hour or resting metabolic rate.\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 also 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":5,"scope_assessment":{"changed":false,"description":"This instrument replaces the 2010 Statement of Principles for the same condition but retains the same statutory purpose: to provide medical‑causation criteria for deciding whether chondromalacia patella is connected with relevant service under the VEA/MRCA. The 2019 instrument updates and clarifies definitions and sets specific quantitative thresholds and time windows (for example MET and running distance criteria, and explicit worsening provisions), and it adds or emphasizes factors such as inability to obtain appropriate clinical management. Those are technical refinements and clarifications rather than a material expansion beyond the original purpose of providing causation criteria for claims."},"complexity_factors":["Repeal and replacement of a prior SOP (s4) — requires comparison with earlier instrument for full context","15 distinct factors in section 9, many duplicated for onset and for clinical worsening (9(1)–9(15) and 9(8)–9(14) overlap)","Multiple precise quantitative thresholds (60 km/week running; 5 METs; ≥6 hours/week; ≥4 weeks; ≥4 hours/day; ≥7 days)","Defined technical terms in Schedule 1 (e.g. \"abnormal tracking of the patella\", \"direct trauma to the patella\", \"MET\", \"terminal event\", \"relevant service\") — ~8–10 defined items","Time‑limited causal windows and differing lookback periods (3 months, 6 months, 4 weeks, 7 days) creating conditional logic","Cross‑reference to ICD‑10‑AM code but explicit override to the instrument’s definition (s7(3)–(4))","Section 11 cross‑references other Statements of Principles — creates layering and potential for overlapping causal tests","Requirement to link factual factor to \"relevant service\" (s10) introduces legal threshold beyond mere medical proof"],"plain_english_summary":"**What this instrument does (mechanics)**\n\n- This is a medical-criteria instrument called a Statement of Principles (SOP) for chondromalacia patella. It tells decision‑makers how to decide, on the balance of probabilities (more likely than not), whether a veteran’s chondromalacia patella (or death contributed to by it) is connected with their relevant service for the purposes of the Veterans' Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA). (See sections 3, 5 and 8.)\n\n- It commenced on 28 January 2019 and repealed the earlier 2010 SOP for the same condition. (Sections 2 and 4.)\n\n- It gives a working medical definition of chondromalacia patella (softening/fibrillation/erosion of the patellar articular cartilage associated with recurrent or chronic patellofemoral pain), and explicitly excludes osteoarthritis of the patellofemoral joint. (Section 7(2).)\n\n- It includes death caused or contributed to by chondromalacia patella (death from a terminal event or condition that the disorder contributed to). (Section 7(5) and the terminal event definition in the Schedule.)\n\n- It lists the specific factual/medical factors (at least one must be present) that, if shown and linked to relevant service, are sufficient to establish that the condition is connected with service on the balance of probabilities. These factors address two scenarios: onset of the condition, and clinical worsening of a pre‑existing condition. (Section 9.)\n\nKey qualifying factors (practical summary of section 9)\n\n- Direct trauma (a blow to the kneecap with immediate pain lasting ≥24 hours) or patellar dislocation to the affected knee within 3 months before clinical onset (or before clinical worsening). (Section 9(1), 9(2), 9(8), 9(9); Schedule definition.)\n\n- An injury producing acute meniscal or ligamentous tear, or permanent ligamentous instability of the affected knee, within 6 months before onset/worsening. (Section 9(3), 9(10).)\n\n- Acquired abnormal patellar tracking for at least 3 months before onset/worsening. (Section 9(4), 9(11); Schedule definition of abnormal tracking.)\n\n- Running/jogging an average of at least 60 km per week for at least 4 weeks before onset/worsening. (Section 9(5), 9(12).)\n\n- Undertaking weight‑bearing exercise that forcefully loads the patellofemoral joint at a minimum intensity of 5 METs (MET defined in the Schedule) for at least 6 hours per week for at least 4 weeks before onset/worsening. (Section 9(6), 9(13).)\n\n- A rapid increase (≥100% increase) in frequency/duration/intensity of weight‑bearing activity involving the affected knee, to at least 5 METs for at least 4 hours per day for at least 7 days before onset/worsening. (Section 9(7), 9(14).)\n\n- Inability to obtain appropriate clinical management for chondromalacia patella (applies where relevant). (Section 9(15).)\n\n- The factors in subsection 9(8)–9(15) (those relating to worsening) only apply to claims of material contribution or aggravation where the condition existed before or during (but did not arise out of) relevant service. (Section 10(2).)\n\n- If a listed factor refers to an injury/disease that is covered by another SOP, that other SOP applies according to its own terms. (Section 11.)\n\n**Official rationale and how it operates in practice**\n\n- The Repatriation Medical Authority (RMA) states that, based on the medical‑scientific evidence it considered, it is more probable than not that chondromalacia patella can be related to relevant service. The SOP translates that view into concrete, testable factual thresholds (for example, time windows, activity intensities and distances) that decision‑makers use when assessing claims. (Section 8.)\n\n- Who decides and who pays: The RMA issues the SOP (it sets the criteria). Claims decision‑makers (within the Department/tribunals) apply the SOP when deciding entitlement under the VEA/MRCA. Financial liability for any benefit flows from those Acts (i.e. the Commonwealth pays where liability is established). (Sections 3, 5, Schedule definitions of VEA/MRCA/relevant service.)\n\n**Practical evidentiary and implementation effects**\n\n- Burden on claimants and clinicians: claimants must supply evidence that one of the listed factors existed and that it is related to their relevant service. Relevant evidence includes service medical records, incident reports, GP/specialist notes, imaging/surgical records, exercise logs or unit fitness records, and evidence about access to clinical care. (Sections 9 and Schedule definitions.)\n\n- Measurement and proof challenges: several qualifying thresholds are precise (for example, 60 km/week running; 5 METs intensity; time windows of 3 months, 6 months, 4 weeks, 7 days). These require documentation or credible contemporaneous reporting. MET values and running distances are not routinely recorded in standard medical notes, which creates an evidentiary burden and potential disputes about whether thresholds are met. (Section 9; Schedule MET definition.)\n\n- Administrative complexity: the SOP contains duplicated sets of factors for onset and clinical worsening, and cross‑references to other SOPs (section 11). Decision‑makers must assess not only medical causation but also whether the particular factor is sufficiently linked to the person’s relevant service. (Sections 9–11.)\n\n- Potential claimant behaviour changes: claimants may focus on assembling evidence tied to the listed thresholds (e.g. fitness logs, unit orders, GP letters). Clinicians may be asked to opine on MET equivalence and tracking abnormalities to meet the SOP tests.\n\n**Costs, trade‑offs and risks (mechanical, not political)**\n\n- Costs and who pays: if the SOP leads to more accepted claims, the Commonwealth bears additional benefit payments and administrative costs. If it narrows acceptances by applying strict thresholds, some claimants who plausibly have service‑related conditions may be excluded. (Sections 5, 8–10.)\n\n- Compliance burden: specific numerical thresholds increase the documentary burden on claimants and their treating clinicians. The requirement for contemporaneous or clearly recorded evidence raises evidentiary costs (medical reports, independent expert reports, fitness logs). (Section 9.)\n\n- Implementation risk and clinical judgment: terms like \"abnormal tracking\" and the application of MET thresholds require clinical interpretation. Different clinicians may reach different views about whether the available evidence meets those definitions or thresholds. (Section 9; Schedule.)\n\n- Interaction with other SOPs: where a factor refers to another injury/disease covered by a separate SOP, that other SOP governs — this can create layers of cross‑reference and may require separate causal assessments. (Section 11.)\n\n**Effects on private actors and markets**\n\n- Limited direct impact on markets: this instrument is a medical‑causation test for veterans’ benefits; it does not regulate private markets directly.\n\n- Indirect effects: it may increase demand for medical assessments, specialist reports, and medico‑legal opinion in the private health and compensation advice markets. Insurers, practitioners and compensation advisors may adopt similar evidentiary standards in analogous contexts.\n\n**What to watch for when preparing or assessing claims**\n\n- Evidence that maps to the SOP thresholds: incident reports, contemporaneous medical notes, imaging/operative notes, unit fitness logs, training schedules, and treatment access records.\n\n- If the claim rests on exercise thresholds or METs, have clinicians explain how the claimant’s activity equates to the required MET levels and durations.\n\n- If the claim relies on inability to obtain appropriate clinical management (section 9(15)), document attempts to access care and timing of any delays.\n\n**Key exclusions and limits**\n\n- Osteoarthritis of the patellofemoral joint is excluded from this SOP’s definition of chondromalacia patella. (Section 7(2)(b).)\n\n- The worsening‑specific factors apply only where the disorder was present before or during service but did not arise out of service. (Section 10(2).)\n\n(References in parentheses are to the section numbers of the Statement of Principles provided.)"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles under the Veterans' Entitlements Act framework. It maintains the same scope as its 2010 predecessor and operates within the established statutory scheme for determining service-related medical conditions. The document does not expand beyond its original purpose of setting medical evidentiary standards for a specific condition."},"complexity_factors":["Moderate cross-referencing: 7 defined terms in Schedule 1, with multiple notes pointing back to the Dictionary","Temporal precision requirements: 8 different time windows specified (3 months, 4 weeks, 6 months, 7 days, etc.)","Technical medical definitions: requires understanding of anatomical terms (patella, femoral condyles, articular cartilage) and exercise physiology (METs)","Dual application structure: factors 1-7 for initial onset, factors 8-14 mirror these for worsening, plus factor 15 for clinical management","Conditional logic in section 10: factors 8-15 only apply to pre-existing conditions aggravated by service, creating a bifurcated test","Nested reference in section 11: incorporates other Statements of Principles by reference, creating interdependence with the broader veterans' compensation scheme","Exclusion clause in section 7(2)(b): explicitly excludes osteoarthritis, requiring diagnostic differentiation"],"plain_english_summary":"This instrument tells veterans and current/former Australian Defence Force members when chondromalacia patella (patellar cartilage damage causing chronic kneecap pain) can be accepted as connected to military service for VEA and MRCA claims. The Repatriation Medical Authority confirms it can be service-related on the balance of probabilities if specific service-linked factors are proven, including new or worsened injury or sustained repetitive loading, and it replaces the 2010 statement."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-chondromalacia-patella-balance-of-probabilities-no-2-of-2019","history":"/api/acts/statement-of-principles-concerning-chondromalacia-patella-balance-of-probabilities-no-2-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-chondromalacia-patella-balance-of-probabilities-no-2-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-chondromalacia-patella-balance-of-probabilities-no-2-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-chondromalacia-patella-balance-of-probabilities-no-2-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-chondromalacia-patella-balance-of-probabilities-no-2-of-2019/documents"}}