{"id":"F2019L00640","name":"Statement of Principles concerning dislocation of a joint and subluxation of a joint (Reasonable Hypothesis) (No. 55 of 2019)","slug":"statement-of-principles-concerning-dislocation-of-a-joint-and-subluxation-of-a-joint-reasonable-hypo","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440056,"registerId":"F2019L00640-fast-fetch-1775955837120","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 (Reasonable Hypothesis) (No. 55 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 (Reasonable Hypothesis)\n\n(No. 55 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 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 (Reasonable Hypothesis) (No. 55 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning dislocation No. 24 of 2010 (Federal Register of Legislation No. F2010L01040) 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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates 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, 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 dislocation of a joint or subluxation of a joint or death from dislocation of a joint or subluxation of a joint 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) being pregnant within the six weeks before the clinical onset of dislocation of a joint or subluxation of a joint;\n\n(6) 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(7) for dislocation of a patellofemoral joint only, being obese at the time of the clinical onset of dislocation of a joint;\n\nNote: being obese is defined in the Schedule 1 - Dictionary.\n\n(8) for dislocation of a tibiofemoral joint or subluxation of a tibiofemoral joint only, being severely obese at the time of the clinical onset of dislocation of a joint or subluxation of a joint;\n\nNote: being severely obese is defined in the Schedule 1 - Dictionary.\n\n(9) 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(10) for dislocation of a total knee joint prosthesis only, having morbid obesity at the time of the clinical onset of dislocation of a joint;\n\n(11) 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(11) 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(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 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 being severely obese means having a Body Mass Index (BMI) of 35 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 not 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) 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 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","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement of an earlier Statement of Principles (No. 24 of 2010). It maintains the same scope—determining medical factors for joint dislocation/subluxation claims under veterans' compensation law. While it expands the specific factors from the 2010 version (adding obesity criteria, pregnancy, and joint-specific factors), this represents an update to medical knowledge rather than scope creep beyond the original purpose of assessing service-related joint dislocations."},"complexity_factors":["11 distinct factors with specific conditional logic (some apply only to specific joints like temporomandibular, patellofemoral, or prosthetic joints)","Cross-references to other Statements of Principles (section 11)","Nested definitions requiring dictionary consultation (e.g., 'soft tissue structure as specified', 'disease process as specified')","Mathematical formula for BMI calculation embedded in definitions","Specific exclusions in section 7(2)(d) (spondylolisthesis, congenital conditions, recurrent instability)","Dual legislative framework application (VEA and MRCA) with different service definitions"],"plain_english_summary":"This instrument replaces the 2010 rule and sets a medical checklist of 11 specific factors that, if at least one is present and service‑connected, permit treating a joint subluxation or dislocation as caused by military service. \n\nIt affects veterans, peacekeepers and current/former defence members claiming under the Veterans' Entitlements Act 1986 or the Military Rehabilitation and Compensation Act 2004 — a crucial threshold for whether joint injury claims succeed."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles concerning dislocation No. 24 of 2010 (s4) and replaces it with the 2019 Statement. The text provided does not enumerate the specific substantive differences between the two instruments, only that the 2010 Statement is repealed and replaced."},"complexity_factors":["Legal threshold: applies the 'reasonable hypothesis' test to connect condition to service (covering causation standard tied to decision-making) (s9, s10).","Medical‑scientific basis requirement: instrument records the Authority's view that sound medical‑scientific evidence supports the connections (s8), creating reliance on clinical evidence and expert interpretation.","Detailed medical factors and exclusions: lists multiple specific clinical and risk factors (trauma, soft tissue damage, fractures, disease processes, pregnancy, BMI thresholds, prosthesis-related conditions) and explicit exclusions (s7(2), s9, Schedule).","Cross‑references to other Statements: factors that refer to other injuries/diseases invoke those other Statements of Principles as in force (s11), adding layered cross‑instrument dependency.","Definitions and numeric thresholds: uses defined terms and measurable criteria (BMI cutoffs at 30, 35; BMI formula) in the Schedule, requiring quantitative assessment (Schedule 1).","Application and administrative scope: instrument applies to claims under VEA and MRCA (s3, s5) so decision makers must map service types (relevant service) to listed factors (Schedule 1 definitions).","Burden and evidentiary practicalities: requirement to show factor existed at clinical onset (s9) and the inclusion of inability to obtain appropriate clinical management as a factor (s9(11)) creates evidentiary and procedural complexities for claimants.","Temporal and causal linking rules: factors must be related to the person's relevant service, and one factor suffices to raise the hypothesis (s9, s10), requiring assessment of timing and causal contribution."],"plain_english_summary":"Replaces the Repatriation Medical Authority's prior Statement of Principles on joint dislocation and subluxation and sets the medical criteria that raise a “reasonable hypothesis” linking those conditions (or death from them) to a person’s relevant military service. It affects veterans and defence members making claims under the VEA or MRCA because it prescribes the medical findings, risk factors (for example BMI thresholds) and service‑relationship rules decision makers must use when assessing entitlement."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-dislocation-of-a-joint-and-subluxation-of-a-joint-reasonable-hypo","history":"/api/acts/statement-of-principles-concerning-dislocation-of-a-joint-and-subluxation-of-a-joint-reasonable-hypo/history","analysis":"/api/acts/statement-of-principles-concerning-dislocation-of-a-joint-and-subluxation-of-a-joint-reasonable-hypo/analysis","conflicts":"/api/acts/statement-of-principles-concerning-dislocation-of-a-joint-and-subluxation-of-a-joint-reasonable-hypo/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-dislocation-of-a-joint-and-subluxation-of-a-joint-reasonable-hypo/important-cases","documents":"/api/acts/statement-of-principles-concerning-dislocation-of-a-joint-and-subluxation-of-a-joint-reasonable-hypo/documents"}}