{"id":"F2023L01461","name":"Statement of Principles concerning chronic exertional compartment syndrome of the lower leg (Balance of Probabilities) (No. 99 of 2023)","slug":"statement-of-principles-concerning-chronic-exertional-compartment-syndrome-of-the-lower-leg-balance-","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442158,"registerId":"F2023L01461-fast-fetch-1775957240034","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning chronic exertional compartment syndrome of the lower leg (Balance of Probabilities) (No. 99 of 2023)","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\n\n \n\nStatement of Principles\n\nconcerning\n\nCHRONIC EXERTIONAL COMPARTMENT SYNDROME OF THE LOWER LEG (Balance of Probabilities)\n\n(No. 99 of 2023)\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 25 October 2023.\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 Terence Campbell AM
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 chronic exertional compartment syndrome of the lower leg (Balance of Probabilities) (No. 99 of 2023).\n\n2 Commencement\n\n This instrument commences on 28 November 2023.\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 shin splints No. 10 of 2015 (Federal Register of Legislation No. F2014L01812) 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 chronic exertional compartment syndrome of the lower leg and death from chronic exertional compartment syndrome of the lower leg.\n\nMeaning of chronic exertional compartment syndrome of the lower leg\n\n(2) For the purposes of this Statement of Principles, chronic exertional compartment syndrome of the lower leg:\n\n(a) means raised muscle compartment pressure manifesting with exercise-induced pain and tightness originating in the calf or shin which typically resolves or reduces with rest; and\n\n(b) excludes:\n\n(i) fracture, including stress fracture;\n\n(ii) lower leg tendinopathies or bursitis;\n\n(iii) nerve entrapments (sural or superfoneal);\n\n(iv) popliteal artery entrapment syndrome;\n\n(v) acute sprain and acute strain; and \n\n(vi) vascular insufficiency.\n\nDeath from chronic exertional compartment syndrome of the lower leg\n\n(3) For the purposes of this Statement of Principles, chronic exertional compartment syndrome of the lower leg, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's chronic exertional compartment syndrome of the lower leg.\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 chronic exertional compartment syndrome of the lower leg and death from chronic exertional compartment syndrome of the lower leg 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, chronic exertional compartment syndrome of the lower leg or death from chronic exertional compartment syndrome of the lower leg is connected with the circumstances of a person's relevant service:\n\n(1) running or jogging an average of at least 60 kilometres per week for the 4 weeks before the clinical onset or clinical worsening of chronic exertional compartment syndrome of the lower leg;\n\n(2) undertaking weight bearing exercise involving repeated activity of the lower leg on the affected side for:\n\n(a) a minimum intensity of 5 METS; and\n\n(b) for at least 6 hours per week; and\n\nfor at least the 4 weeks before the clinical onset or clinical worsening of chronic exertional compartment syndrome of the lower leg;\n\nNote 1: Examples of weight bearing exercise involving repeated activity of the lower leg at a minimum intensity of 5 METS include marching, sustained brisk walking, playing football, and dancing.\n\nNote 2: MET is defined in the Schedule 1 - Dictionary.\n\n(3) increasing the frequency, duration or intensity of weight bearing activity involving the lower leg on the affected side:\n\n(a) by at least 100 percent; and\n\n(b) to a minimum intensity of 5 METs; and\n\n(c) for at least 4 hours per day;\n\nwithin the one week before the clinical onset or clinical worsening of chronic exertional compartment syndrome of the lower leg;\n\nNote: MET is defined in the Schedule 1 - Dictionary.\n\n(4) inability to obtain appropriate clinical management for chronic exertional compartment syndrome of the lower leg before the clinical worsening of chronic exertional compartment syndrome of the lower leg.\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 clinical worsening aspects of factors set out in section 9 apply only to material contribution to, or aggravation of, chronic exertional compartment syndrome of the lower leg where the person's chronic exertional compartment syndrome of the lower leg 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 chronic exertional compartment syndrome of the lower leg—see subsection 7(2).\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, or 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 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 prior \"shin splints\" Statement of Principles No.10 of 2015 (s4) and replaces it with a Statement specific to chronic exertional compartment syndrome of the lower leg (s7). It narrows and redefines the covered condition with explicit exclusions (s7(2)), adds quantified activity and timing thresholds for establishing service connection (s9), and expressly includes death from CECS (s7(3)). It applies to claims under VEA s120B and MRCA s339 (s5)."},"complexity_factors":["Technical medical definition and exclusions (s7(2)): distinguishing CECS from fractures, tendinopathies, nerve entrapments, vascular problems and acute sprain/strain.","Quantified activity thresholds (s9(1)–(3)): running ≥60 km/week; MET-based minimum intensity (5 METs); hours-per-week and hours-per-day thresholds; 100% increase metric.","Timing requirements (s9): specific pre-onset windows (4 weeks, 1 week) for onset or clinical worsening.","Non‑clinical factor (s9(4)): inability to obtain appropriate clinical management as a qualifying factor introduces evidentiary and access-assessment issues.","Causation standard and service link (ss8,10): 'balance of probabilities' test and explicit requirement that factors be related to relevant service.","Interaction with other Statements (s11): cross-reference to other SOPs where a factor refers to a different covered injury/disease.","Definitions and measurement conversions (Schedule 1): MET definition, 'terminal event', and 'relevant service' categories that must be applied consistently.","Repeal and scope change (s4): replacing a prior instrument raises transitional and comparability questions for existing claims."],"plain_english_summary":"This instrument establishes a Statement of Principles for chronic exertional compartment syndrome (CECS) of the lower leg and death from CECS, replacing a prior \"shin splints\" statement. It applies to claims under the VEA and MRCA and sets a medical definition, exclusions, and concrete qualifying factors—quantified exercise thresholds, timing windows and lack of access to care—that, when linked to a person’s relevant service, are taken to establish a service connection on the balance of probabilities and guide entitlement decisions."},"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":3,"scope_assessment":{"changed":true,"description":"The legislation narrows scope compared to its predecessor. It replaces the 2015 'shin splints' Statement of Principles with a specific, medically precise condition (chronic exertional compartment syndrome). The 2015 instrument covered a broader, less defined category of lower leg pain, while this 2023 version specifically defines CECS, excludes six related conditions (fractures, tendinopathies, nerve entrapments, etc.), and sets precise exercise thresholds. This represents a shift from a general 'catch-all' approach to a targeted, evidence-based definition of a specific diagnosable condition."},"complexity_factors":["Short, focused instrument (approximately 1,500 words) dealing with single medical condition","Only 6 defined terms in the Dictionary (MET, MRCA, relevant service, terminal event, VEA, and the condition itself)","Clear, numbered list of only 4 factors in section 9 with specific quantitative thresholds (60km/week, 5 METs, 6 hours/week, 100% increase, 4 hours/day)","Simple conditional structure: 'at least one of the following factors must exist'","Single cross-reference mechanism in section 11 for related conditions, but no complex nesting","Exclusions list in section 7(2) is explicit and closed (6 specific exclusions)","No exceptions to exceptions or deeply nested subsections"],"plain_english_summary":"This instrument replaces the 2015 “shin splints” policy and sets the legal test for linking chronic exertional compartment syndrome of the lower leg (CECS) to military service. It tells veterans and current/former Defence members how CECS claims are decided under the relevant compensation laws, using the balance‑of‑probabilities standard, and clarifies when service causes or materially worsens the condition."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-chronic-exertional-compartment-syndrome-of-the-lower-leg-balance-","history":"/api/acts/statement-of-principles-concerning-chronic-exertional-compartment-syndrome-of-the-lower-leg-balance-/history","analysis":"/api/acts/statement-of-principles-concerning-chronic-exertional-compartment-syndrome-of-the-lower-leg-balance-/analysis","conflicts":"/api/acts/statement-of-principles-concerning-chronic-exertional-compartment-syndrome-of-the-lower-leg-balance-/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-chronic-exertional-compartment-syndrome-of-the-lower-leg-balance-/important-cases","documents":"/api/acts/statement-of-principles-concerning-chronic-exertional-compartment-syndrome-of-the-lower-leg-balance-/documents"}}