{"id":"F2023L01460","name":"Statement of Principles concerning chronic exertional compartment syndrome of the lower leg (Reasonable Hypothesis) (No. 98 of 2023)","slug":"statement-of-principles-concerning-chronic-exertional-compartment-syndrome-of-the-lower-leg-reasonab","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442159,"registerId":"F2023L01460-fast-fetch-1775957240035","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 (Reasonable Hypothesis) (No. 98 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 (Reasonable Hypothesis)\n\n(No. 98 of 2023)\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 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:
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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 (Reasonable Hypothesis) (No. 98 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning shin splints No.9 of 2015 (Federal Register of Legislation No. F2014L01805) 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 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(a) 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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates 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, 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 chronic exertional compartment syndrome of the lower leg or death from chronic exertional compartment syndrome of the lower leg with the circumstances of a person's relevant service:\n\n(1) running or jogging an average of at least 30 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 4 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 2 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(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 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) 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 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_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":4,"scope_assessment":{"changed":false,"description":"This instrument maintains its original narrow scope. It replaces a 2015 Statement of Principles concerning 'shin splints' with a more medically precise instrument focused specifically on chronic exertional compartment syndrome. The scope has not expanded beyond its intended purpose of determining service connection for a specific lower leg condition in the veterans' compensation system."},"complexity_factors":["Moderate cross-referencing between two major Acts (VEA and MRCA) with six different service types defined","Scientific measurement unit (MET) requiring technical definition involving oxygen consumption and metabolic rates","Multiple temporal conditions ('4 weeks before', 'one week before', 'at least 2 hours per day') that must be precisely calculated","Nested exclusions in the disease definition (6 specific conditions ruled out in subsection 7(2))","Conditional logic in section 10 distinguishing between conditions arising during service versus pre-existing conditions aggravated by service","Self-referential mechanism in section 11 allowing incorporation of other Statements of Principles by reference","Specific percentage thresholds (100% increase in activity) and quantitative thresholds (30km, 5 METs, 4 hours)"],"plain_english_summary":"This law sets medical criteria for when chronic exertional compartment syndrome of the lower leg is treated as service-related for compensation, replacing earlier “shin splints” rules. It affects current and former ADF members, veterans and DVA decision-makers by defining objective activity-based links to service (e.g., sustained running, regular moderate weight-bearing exercise, sudden spikes in intensity, or lack of timely treatment). Using measures like METs, it aims to make claims assessments more consistent and evidence-based."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument repeals the earlier 'shin splints' Statement (s4) and replaces it with a Statement focused on chronic exertional compartment syndrome of the lower leg (s7). It narrows and clarifies the medical condition with express exclusions (s7(2)), adds explicit activity‑based exposure thresholds and a clinical‑care factor (s9), and includes death from CECS (s7(3)). It applies to claims under the VEA and MRCA (s5). These changes alter the population of claims captured and the evidentiary tests claimants must meet."},"complexity_factors":["Medical definition with express exclusions (definition and exclusions: s7(2)) increases diagnostic specificity and requires clinical interpretation.","Quantitative exposure thresholds require retrospective measurement of activity (running ≥30 km/week: s9(1); weight-bearing ≥5 METs ≥4 hrs/week: s9(2); 100% increase to ≥5 METs ≥2 hrs/day within 1 week: s9(3)).","Inclusion of death tied to a terminal event broadens consequences to fatal outcomes (death included: s7(3); terminal event defined in Schedule).","Application and claimant scope set by statute references and repeal of prior instrument (applies to claims under s120A VEA or s338 MRCA: s5; repeal of shin splints SOP: s4).","Service‑connection requirement and limits on aggravation claims require linking exposures to 'relevant service' and constrain clinical worsening rules to pre‑existing conditions (s10(1)–(2)).","Interaction with other Statements of Principles creates cross‑reference complexity where factors overlap with other conditions (s11).","Evidentiary and discretion issues: the RMA adopts a 'reasonable hypothesis' standard and states a scientific view (s8); adjudicators must assess whether documented facts meet that threshold.","Subjective/administrative factor—'inability to obtain appropriate clinical management'—is open to interpretation and may increase administrative discretion and proof burden (s9(4)).","Technical measurement requirement (MET definition in Schedule) means claimants or clinicians must translate activities into METs, adding quantification complexity (Schedule: MET definition)."],"plain_english_summary":"This Statement of Principles sets the medical criteria the Repatriation Medical Authority uses to link chronic exertional compartment syndrome (CECS) of the lower leg — and death contributed to by it — to veterans’ relevant service for VEA/MRCA claims. It defines CECS, replaces an earlier “shin splints” instrument, and lists activity-based exposure thresholds (eg running ≥30 km/week; weight‑bearing at ≥5 METs for specified durations) and lack of appropriate clinical care as factors. Meeting at least one factor tied to relevant service raises a reasonable hypothesis for entitlement."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-chronic-exertional-compartment-syndrome-of-the-lower-leg-reasonab","history":"/api/acts/statement-of-principles-concerning-chronic-exertional-compartment-syndrome-of-the-lower-leg-reasonab/history","analysis":"/api/acts/statement-of-principles-concerning-chronic-exertional-compartment-syndrome-of-the-lower-leg-reasonab/analysis","conflicts":"/api/acts/statement-of-principles-concerning-chronic-exertional-compartment-syndrome-of-the-lower-leg-reasonab/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-chronic-exertional-compartment-syndrome-of-the-lower-leg-reasonab/important-cases","documents":"/api/acts/statement-of-principles-concerning-chronic-exertional-compartment-syndrome-of-the-lower-leg-reasonab/documents"}}