{"id":"F2019L00647","name":"Statement of Principles concerning dislocation of a joint and subluxation of a joint (Balance of Probabilities) (No. 56 of 2019)","slug":"statement-of-principles-concerning-dislocation-of-a-joint-and-subluxation-of-a-joint-balance-of-prob","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440058,"registerId":"F2019L00647-fast-fetch-1775955839230","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning dislocation of a joint and subluxation of a joint (Balance of Probabilities) (No. 56 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\nDISLOCATION OF A JOINT AND SUBLUXATION OF A JOINT (Balance of Probabilities)\n\n(No. 56 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 26 April 2019\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 dislocation of a joint and subluxation of a joint (Balance of Probabilities) (No. 56 of 2019).\n\n2 Commencement\n\n This instrument commences on 27 May 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 dislocation No. 25 of 2010 (Federal Register of Legislation No. F2010L01041) 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 dislocation of a joint and subluxation of a joint and death from dislocation of a joint and subluxation of a joint.\n\nMeaning of dislocation of a joint and subluxation of a joint\n\n(2) For the purposes of this Statement of Principles:\n\n(a) dislocation of a joint means an episode of displacement of a joint such that there is complete loss of contact between the articulating surfaces of the bones or internal joint prosthesis; and\n\n(b) subluxation of a joint means an episode of displacement of a joint such that there is partial loss of contact between the articulating surfaces of the bones or internal joint prosthesis; and\n\n(c) dislocation of a joint and subluxation of a joint includes:\n\n(i) joint dissociation; and\n\n(ii) dislocation or subluxation at a synchondrosis, syndesmosis or an internal joint prosthesis; and\n\n(d) dislocation of a joint and subluxation of a joint excludes spondylolisthesis, congenital dislocation or subluxation, recurrent dislocation or subluxation due to joint instability, and loosening or migration of an internal joint prosthesis.\n\nDeath from dislocation of a joint or subluxation of a joint\n\n(3) For the purposes of this Statement of Principles, dislocation of a joint or subluxation of a joint, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's dislocation of a joint or subluxation of a joint.\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 dislocation of a joint or subluxation of a joint and death from dislocation of a joint or subluxation of a joint 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, dislocation of a joint or subluxation of a joint or death from dislocation of a joint or subluxation of a joint is connected with the circumstances of a person's relevant service:\n\n(1) having physical trauma to the affected joint at the time of the clinical onset of dislocation of a joint or subluxation of a joint;\n\nNote: Examples of activities and circumstances involving trauma to the affected joint include, but are not limited to, falls, collisions, lifting weights, push ups, pull ups, throwing objects, seizure and electrical injury. \n\n(2) having damage to a soft tissue structure as specified at the time of the clinical onset of dislocation of a joint or subluxation of a joint;\n\nNote: soft tissue structure as specified is defined in the Schedule 1 - Dictionary.\n\n(3) having a fracture, avulsion or bony abnormality involving the articulating surfaces of the affected joint, at the time of the clinical onset of dislocation of a joint or subluxation of a joint;\n\nNote: Examples of conditions which can cause a bony abnormality include, but are not limited to, osteonecrosis, dysbaric osteonecrosis and femoroacetabular impingement.\n\n(4) having a disease process as specified affecting the normal structural or functional relationship between the articulating surfaces of the affected joint at the time of the clinical onset of dislocation of a joint or subluxation of a joint;\n\nNote: disease process as specified is defined in the Schedule 1 – Dictionary.\n\n(5) for dislocation of a temporomandibular joint or subluxation of a temporomandibular joint only, undertaking an activity or undergoing a medical procedure that involves wide opening of the mouth at the time of the clinical onset of dislocation of a joint or subluxation of a joint;\n\nNote 1: Examples of activities which may involve wide mouth opening include, but are not limited to, yawning, laughing, vomiting, coughing, and chewing large pieces of food.\n\nNote 2: Examples of medical procedures that involve wide mouth opening include, but are not limited to, dental procedures, direct laryngoscopy, and intravenous administration of medications which cause drug-induced yawning.\n\n(6) for dislocation of a tibiofemoral joint or subluxation of a tibiofemoral joint only, having morbid obesity at the time of the clinical onset of dislocation of a joint or subluxation of a joint;\n\n(7) for dislocation of a total hip joint prosthesis only:\n\n(a) being obese at the time of the clinical onset of dislocation of a joint; or\n\nNote: being obese is defined in the Schedule 1 - Dictionary.\n\n(b) having lumbar spondylosis, lumbar intervertebral disc prolapse, lumbar spondylolisthesis, lumbar spinal stenosis or lumbar spinal fusion at the time of the clinical onset of dislocation of a joint;\n\n(8) inability to obtain appropriate clinical management for dislocation of a joint or subluxation of a joint.\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 factor set out in subsection 9(8) applies only to material contribution to, or aggravation of, dislocation of a joint or subluxation of a joint where the person's dislocation of a joint or subluxation of a joint 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 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\n BMI 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 disease process as specified means:\n\n(a) a neurological, neuromuscular or muscular condition, including, but not limited to, brain or spinal injuries with spasticity or flaccid paralysis, cerebrovascular accident, Parkinson's disease, myasthenia gravis, poliomyelitis, dyskinesia caused by neuroleptic drugs, and peripheral neuropathy; or\n\n(b) an infective, inflammatory or degenerative condition of the affected joint, including, but limited to, septic arthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthropathy, crystal arthropathy, Grisel syndrome and osteoarthritis; or\n\n(c) an intra-articular space occupying lesion, including, but not limited to, neoplastic lesions such as sarcoma, osteosarcoma, chondrosarcoma and pigmented villonodular synovitis.\n\nNote: Grisel syndrome is atlantoaxial joint subluxation due to contiguous inflammation from the ear, nose or throat.\n\n dislocation of a joint and subluxation of a joint—see subsection 7(2).\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 soft tissue structure as specified means a joint capsule, tendon, ligament or fibrocartilaginous structure that contributes to joint stability in the affected joint.\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\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument replaces the earlier Statement of Principles on dislocation (No. 25 of 2010) (see s4) but remains focused on the same medical condition group (dislocation and subluxation of joints) and its connection to relevant service. The replacement refines definitions (adds explicit inclusions such as internal joint prostheses and joint dissociation, and explicit exclusions), and adds or clarifies specific factors (for example, joint‑specific factors for TMJ, tibiofemoral and total hip prosthesis, and explicit BMI thresholds). Those are technical and diagnostic updates rather than a material broadening of the Statement’s original subject‑matter or policy purpose."},"complexity_factors":["Single topic instrument with 11 short substantive sections plus a Dictionary (limited length)","Around 9–11 defined terms in Schedule 1 (BMI, being obese, disease process as specified, soft tissue structure as specified, terminal event, relevant service, MRCA, VEA, dislocation/subluxation definition, etc.)","Eight discrete causation factors listed in section 9, including joint‑specific sub‑conditions (TMJ, tibiofemoral, total hip prosthesis) that add conditional logic","Some cross‑referencing to other Statements of Principles (s11) and to VEA/MRCA (s3, s5), creating limited external dependency","A few exclusions and narrow temporal rules (e.g. s7(2)(d) exclusions; s10(2) limits the operation of s9(8))","Use of medical concepts that require interpretive judgment (\"clinical onset\", \"related to relevant service\", \"inability to obtain appropriate clinical management\") which raise evidentiary complexity despite statutory simplicity"],"plain_english_summary":"**What this instrument does (mechanically)\n\n- It is a Statement of Principles used to decide, on the balance of probabilities, whether a dislocation or subluxation of a joint (or death from one) can be connected to a veteran's or member's \"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, 7 and 8).\n\n- It defines what counts as a dislocation or subluxation and what is excluded (for example, congenital dislocation, recurrent dislocation from chronic joint instability, and loosening of a prosthesis are excluded) (see s7(2)).\n\n- It lists the specific medical and circumstantial factors which must exist for a claim to be accepted as connected to service. At least one of the listed factors must be present at the time the condition began (\"clinical onset\") for a link to service to be accepted (see s9). Those factors include:\n - physical trauma to the affected joint at clinical onset (examples given: falls, collisions, lifting, seizures) (s9(1));\n - damage to a soft tissue structure that contributes to joint stability (s9(2));\n - fracture, avulsion or bony abnormality of the articulating surfaces (s9(3));\n - a specified disease process affecting the joint (s9(4); Schedule definitions);\n - for temporomandibular joint (TMJ) dislocation/subluxation only: activities or medical procedures that involve wide opening of the mouth at clinical onset (s9(5));\n - for tibiofemoral joint only: morbid obesity at clinical onset (s9(6));\n - for dislocation of a total hip prosthesis only: obesity or specified lumbar spine conditions at clinical onset (s9(7));\n - inability to obtain appropriate clinical management (s9(8)).\n\n- The statement requires that any of the factors relied on must be related to the person's relevant service (s10). The inability-to-treat factor (s9(8)) only applies in a narrow way where the dislocation was suffered or contracted before or during, but did not arise out of, the person's relevant service (s10(2)).\n\n- If a factor in this statement refers to an injury or disease that is covered by another Statement of Principles, the other Statement applies in the terms of that Statement (s11).\n\n- The instrument also defines technical terms used (Schedule 1). Important definitions include BMI and the threshold for \"being obese\" (BMI ≥ 30), \"disease process as specified\" (lists neurological, infective, inflammatory, degenerative and intra‑articular lesions), \"soft tissue structure as specified\", \"terminal event\" (examples of proximate causes of death), and \"relevant service\" (types of service under the VEA and MRCA) (Schedule 1).\n\nWho this affects\n\n- Veterans and current/former members of the Australian Defence Force who lodge claims under the VEA or MRCA for a dislocation or subluxation (or death from one). The Statement is used by decision-makers who determine entitlement to benefits.\n\n- Treating clinicians and medico‑legal examiners: clinical records that show trauma, soft‑tissue damage, bony injury, relevant disease processes, BMI at onset, or inability to obtain care will be central to linking the condition to service.\n\nWhy it matters\n\n- This Statement sets the medical criteria used to decide whether a dislocation/subluxation is connected to service and therefore whether a claimant may be entitled to compensation or rehabilitation under VEA or MRCA. It reduces uncertainty by listing specific factors that, if shown to exist and to relate to service, will satisfy causation on the balance of probabilities (see s8–s9).\n\nPractical and incentive effects, trade‑offs and implementation considerations\n\n- Who pays: if the condition is determined to be service‑connected under VEA/MRCA, the Commonwealth (through relevant agencies) may bear costs of compensation, treatment and rehabilitation.\n\n- Who decides and how: the Repatriation Medical Authority issues the Statement (s3); administrative decision‑makers apply it to individual claims. The decision hinges on medical evidence that a listed factor existed at clinical onset and that the factor relates to relevant service (s9–s10).\n\n- Evidence and compliance burden: claimants must produce medical records or other evidence showing the timing and nature of trauma, imaging or operative evidence of fractures/bony abnormality, documentation of soft tissue damage, BMI at or near onset, records of inability to obtain care, or evidence of specific disease processes. The requirement to show the factor existed at clinical onset creates a need for contemporaneous or reliable historical medical evidence.\n\n- Allocation of causation between service and personal factors: the Statement lists personal risk factors (e.g. obesity, certain disease processes). Where such factors are present, decision‑makers must consider whether they were related to the person's service; that can reduce or complicate attribution to service depending on the evidence (see s9(6)–(7) and Schedule 1 definitions).\n\n- Linkages and potential for cross‑reference complexity: section 11 requires application of other Statements of Principles where a listed factor is covered by another Statement; this channels cases to other specialized statements but introduces cross‑reference and potential layering of medical rules.\n\n- Limited scope for some scenarios: exclusions (s7(2)(d)), and the narrow operation of the inability‑to‑treat factor (s10(2)), constrain when the Statement can support a claim. Decision‑makers will need to distinguish acute, service‑related events from chronic or congenital conditions that are excluded.\n\n- Concentrated benefits, diffuse costs: the direct beneficiaries are claimants with qualifying evidence; costs of accepted claims are borne by the Commonwealth, with administrative costs for assessment and potential downstream treatment liability.\n\n- Implementation risks: disputes about timing of \"clinical onset\", whether a listed medical condition pre‑existed service, and the degree to which a factor is \"related to\" service will generate contested medical opinion and possible appeals.\n\nSources of legal mechanics cited above: sections 3, 5, 7–11 and Schedule 1 of the instrument."},"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 instrument maintains the established scope of Repatriation Medical Authority Statements of Principles. It replaces the 2010 version concerning dislocation (No. 25 of 2010) with updated medical-scientific evidence but does not expand beyond the original purpose of establishing causal factors for service-related joint dislocation claims. The inclusion of subluxation alongside dislocation appears to be a clarification/expansion of the existing subject matter rather than a fundamental scope change."},"complexity_factors":["Multiple conditional factors with joint-specific carve-outs (factors 5, 6, and 7 apply only to specific joints: temporomandibular, tibiofemoral, and total hip prosthesis respectively)","Cross-referencing structure: section 11 requires readers to consult other Statements of Principles when factors refer to injuries covered elsewhere","Nested definitions: 'disease process as specified' contains three sub-categories with non-exhaustive lists (a), (b), (c)","Dual legislative framework application: instrument applies to both VEA and MRCA claims with different service definitions","Mathematical formula for BMI definition requiring calculation","Exclusion list in section 7(2)(d) that removes certain conditions from scope"],"plain_english_summary":"This instrument updates the Repatriation Medical Authority’s Statement of Principles for joint dislocations/subluxations, replacing the 2010 test used to decide if such injuries are related to service. It governs compensation decisions under the Veterans’ Entitlements and Military Rehabilitation and Compensation Acts and affects current/former ADF members, the RMA, and DVA decision-makers.\n\nThe legal test requires at least one specified medical or causal factor to be present for a dislocation to be considered service-related, with several medical exclusions."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-dislocation-of-a-joint-and-subluxation-of-a-joint-balance-of-prob","history":"/api/acts/statement-of-principles-concerning-dislocation-of-a-joint-and-subluxation-of-a-joint-balance-of-prob/history","analysis":"/api/acts/statement-of-principles-concerning-dislocation-of-a-joint-and-subluxation-of-a-joint-balance-of-prob/analysis","conflicts":"/api/acts/statement-of-principles-concerning-dislocation-of-a-joint-and-subluxation-of-a-joint-balance-of-prob/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-dislocation-of-a-joint-and-subluxation-of-a-joint-balance-of-prob/important-cases","documents":"/api/acts/statement-of-principles-concerning-dislocation-of-a-joint-and-subluxation-of-a-joint-balance-of-prob/documents"}}