{"id":"F2018L01834","name":"Statement of Principles concerning chondromalacia patella (Reasonable Hypothesis) (No. 1 of 2019)","slug":"statement-of-principles-concerning-chondromalacia-patella-reasonable-hypothesis-no-1-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439889,"registerId":"F2018L01834-fast-fetch-1775955738058","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning chondromalacia patella (Reasonable Hypothesis) (No. 1 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 (Reasonable Hypothesis)\n\n(No. 1 of 2019)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) 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 (Reasonable Hypothesis) (No. 1 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning chondromalacia patella No. 79 of 2010 (Federal Register of Legislation No. F2010L02318) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that chondromalacia patella and death from chondromalacia patella can be related to relevant service rendered by veterans, members of Peacekeeping Forces, 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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting chondromalacia patella or death from chondromalacia patella 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 30 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 four 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 two 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) being obese at the time of the clinical onset of chondromalacia patella;\n\nNote: being obese is defined in the Schedule 1 - Dictionary. \n\n(9) 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(10) having patellar dislocation of the affected knee within the three months before the clinical worsening of chondromalacia patella;\n\n(11) 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(12) 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(13) running or jogging an average of at least 30 kilometres per week for at least the four weeks before the clinical worsening of chondromalacia patella;\n\n(14) undertaking weight bearing exercise involving forceful loading of the affected patellofemoral joint, at a minimum intensity of five METs for at least four 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(15) 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 two 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(16) being obese at the time of the clinical worsening of chondromalacia patella;\n\nNote: being obese is defined in the Schedule 1 - Dictionary. \n\n(17) 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(9) to 9(17) 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(2) 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 being obese means having a Body Mass Index (BMI) of 30 or greater.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\nBMI means W/H2 where:\n\nW is the person's weight in kilograms; and\n\nH is the person's height in metres.\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) operational service under the VEA;\n\n(b) peacekeeping service under the VEA;\n\n(c) hazardous service under the VEA;\n\n(d) British nuclear test defence service under the VEA;\n\n(e) warlike service under the MRCA; or\n\n(f) non-warlike 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":true,"description":"This instrument expressly repeals the earlier Statement of Principles concerning chondromalacia patella (No. 79 of 2010) (s4) and replaces it. Its scope as set here applies to claims under section 120A of the VEA or section 338 of the MRCA (s5), defines chondromalacia patella and excludes patellofemoral osteoarthritis (s7(2)), includes death from a terminal event contributed to by the condition (s7(5)), and specifies a set of service‑related medical and activity factors and timeframes that must exist to raise a reasonable hypothesis connecting the condition to service (s9–s10)."},"complexity_factors":["Technical medical definitions and exclusions (chondromalacia patella defined; osteoarthritis excluded) (s7(2))","Multiple, specific quantitative thresholds (running ≥30 km/week; METs ≥5; BMI ≥30) require numeric measurement and verification (s9(5), s9(6), s9(8); Schedule)","Short, distinct temporal windows for causation and for clinical worsening (3 months, 6 months, 4 weeks, 7 days) increase evidentiary tracing (s9)","Different criteria for new onset versus aggravation/material contribution when condition pre‑existing or arises outside service (s10(2))","Overlap and cross‑reference to other Statements of Principles where an injury/disease is separately covered, requiring inter‑instrument interpretation (s11)","Inclusion of death from a terminal event contributed to by the condition, requiring proximate‑cause analysis (s7(5); Schedule)","Replaces a prior Statement (repeal), so claim handlers must map older files to the new criteria (s4)","Application limited to claims under specific statutes (VEA and MRCA), so legal eligibility rules must be checked alongside medical criteria (s5)","Some concepts require clinical judgement (eg abnormal patellar tracking, inability to obtain appropriate clinical management), creating discretionary assessment points (Schedule; s9(17))"],"plain_english_summary":"This Statement of Principles sets the medical tests and thresholds used to decide whether chondromalacia patella (softening/erosion of the kneecap’s articular cartilage, excluding patellofemoral osteoarthritis) can be reasonably connected to military or peacekeeping service for veterans’ compensation claims. It lists specific clinical events, activities and risk factors (for example: direct patella trauma, patellar dislocation, meniscal/ligament injury, high‑volume running, forceful weight‑bearing measured in METs, obesity, or lack of appropriate care) and time limits for onset or worsening.\n\nIt also covers death from a terminal event if contributed to by the condition, replaces the earlier 2010 Statement of Principles, and applies to claims under the VEA and MRCA."},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement instrument maintaining the established scope of Repatriation Medical Authority determinations. It updates the 2010 version without expanding beyond the original purpose of establishing medical connection factors for chondromalacia patella in veterans' compensation claims."},"complexity_factors":["17 distinct factors with specific temporal windows (3 months, 4 weeks, 6 months, 7 days) requiring precise date calculations","Dual structure covering both clinical onset (factors 1-8) and clinical worsening (factors 9-16) plus a standalone treatment factor (17)","Cross-referential definitions: 7 defined terms in Schedule 1, with some definitions containing nested definitions (e.g., 'being obese' refers to BMI, which has its own formula)","Conditional limitation in section 10(2) restricting factors 9-17 to pre-existing conditions not arising from service","Incorporation by reference to ICD-10-AM Tenth Edition (external medical classification system)","Section 11 creates dynamic incorporation of other Statements of Principles by reference 'as in force from time to time'"],"plain_english_summary":"This replaces the 2010 medical rules for chondromalacia patella (cartilage damage behind the kneecap) with a new checklist of 17 factors that, if shown, create a \"reasonable hypothesis\" the condition was caused or worsened by ADF service. \n\nIt affects current and former Australian Defence Force members claiming under the Veterans' Entitlements Act or Military Rehabilitation and Compensation Act — because establishing a reasonable hypothesis shifts the benefit of the doubt toward the veteran."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-chondromalacia-patella-reasonable-hypothesis-no-1-of-2019","history":"/api/acts/statement-of-principles-concerning-chondromalacia-patella-reasonable-hypothesis-no-1-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-chondromalacia-patella-reasonable-hypothesis-no-1-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-chondromalacia-patella-reasonable-hypothesis-no-1-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-chondromalacia-patella-reasonable-hypothesis-no-1-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-chondromalacia-patella-reasonable-hypothesis-no-1-of-2019/documents"}}