{"id":"F2023L00020","name":"Statement of Principles concerning epicondylitis (Balance of Probabilities) (No. 6 of 2023)","slug":"statement-of-principles-concerning-epicondylitis-balance-of-probabilities-no-6-of-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":103705,"registerId":"commonwealth-F2023L00020-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning epicondylitis (Balance of Probabilities) (No. 6 of 2023)","content":"![RMA Australian Government Coat of Arms](image.001.jpeg)\n\nStatement of Principles\n\nconcerning\n\nEPICONDYLITIS  \n(Balance of Probabilities)\n\n(No. 6 of 2023)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\nDated 23 December 2022.\n\n| The Common Seal of theRepatriation Medical Authoritywas affixed to this instrumentat the direction of: |\n| ------------------------------------------------------------------------------------------------------ |\n| Professor Terence Campbell AMChairperson                                                               |\n\n  \n\nContents\n\n1 Name....................................................3\n\n2 Commencement.............................................3\n\n3 Authority..................................................3\n\n4 Repeal...................................................3\n\n5 Application................................................3\n\n6 Definitions................................................3\n\n7 Kind of injury, disease or death to which this Statement of Principles relates.....3\n\n8 Basis for determining the factors..................................4\n\n9 Factors that must exist.........................................4\n\n10 Relationship to service.........................................5\n\n11 Factors referring to an injury or disease covered by another Statement of Principles.5\n\nSchedule 1 - Dictionary...............................................7\n\n1 Definitions................................................7\n\n  \n\n1.  Name\n\nThis is the Statement of Principles concerning epicondylitis (Balance of Probabilities) (No. 6 of 2023).\n\n1.  Commencement\n\nThis instrument commences on 23 January 2023.\n\n1.  Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.  Repeal\n\nThe Statement of Principles concerning epicondylitis No. 8 of 2015 (Federal Register of Legislation No. F2014L01786) made under subsection 196B(3) of the VEA is repealed.\n\n1.  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\n1.  Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.  Kind of injury, disease or death to which this Statement of Principles relates\n    1.  This Statement of Principles is about epicondylitis and death from epicondylitis.\n\nMeaning of epicondylitis\n\n1.  For the purposes of this Statement of Principles, epicondylitis:\n    1.  means a clinically symptomatic inflammatory or degenerative disorder of the tendons that attach to the medial or lateral epicondyle of the elbow; and\n    2.  includes medial epicondylitis and lateral epicondylitis.\n\n> Note 1: Epicondylitis typically presents with pain and tenderness over the medial or lateral epicondyle, with exacerbation of pain by the use of the muscles of the forearm, such as with wrist extension in lateral epicondylitis or with wrist flexion in medial epicondylitis.\n\n> Note 2: Lateral epicondylitis is also known as tennis elbow. Medial epicondylitis is also known as golfer's elbow.\n\n> Note 3: Epicondylitis is also known as elbow tendinopathy.\n\n1.  While epicondylitis attracts ICD‑10‑AM codes M77.0 or M77.1, in applying this Statement of Principles the meaning of epicondylitis is that given in subsection (2).\n2.  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 epicondylitis\n\n1.  For the purposes of this Statement of Principles, epicondylitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's epicondylitis.\n\n> Note: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.  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 epicondylitis and death from epicondylitis can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\n> Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.\n\n1.  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, epicondylitis or death from epicondylitis is connected with the circumstances of a person's relevant service:\n\n1.  performing forceful activities with the hand or forearm on the affected side, in combination with:\n    1.  repetitive activities with the hand or forearm on the affected side; or\n    2.  sustained activities with the hand or forearm on the affected side;\n\nfor at least 1 hour per day, on more days than not, over a period of at least the 3 months before the clinical onset of epicondylitis;\n\n> Note: Performing forceful and repetitive or forceful and sustained activities with the hand or forearm can occur as compensation for disability in the contralateral upper limb (including epicondylitis or amputation), or with manual wheelchair use. Activities with the hand or forearm involve bending or straightening of the elbow; rotation, pronation, supination, twisting or screwing motion of the forearm; and flexion, extension or bending of the wrist or hand.\n\n1.  using a hand-held computer mouse on the affected side for at least 20 hours per week in the 1 year before the clinical onset of epicondylitis;\n2.  taking a fluoroquinolone antibiotic within the 14 days before the clinical onset of epicondylitis;\n\n> Note: Examples of fluoroquinolone antibiotics include ciprofloxacin, moxifloxacin, norfloxacin and ofloxacin.\n\n1.  having spondyloarthritis at the time of the clinical onset of epicondylitis;\n\n> Note: spondyloarthritis is defined in the Schedule 1 – Dictionary.\n\n1.  performing forceful activities with the hand or forearm on the affected side, in combination with:\n    1.  repetitive activities with the hand or forearm on the affected side; or\n    2.  sustained activities with the hand or forearm on the affected side;\n\nfor at least 1 hour per day, on more days than not, over a period of at least the 3 months before the clinical worsening of epicondylitis;\n\n> Note: Performing forceful and repetitive or forceful and sustained activities with the hand or forearm can occur as compensation for disability in the contralateral upper limb (including epicondylitis or amputation), or with manual wheelchair use. Activities with the hand or forearm involve bending or straightening of the elbow; rotation, pronation, supination, twisting or screwing motion of the forearm; and flexion, extension or bending of the wrist or hand.\n\n1.  using a hand-held computer mouse on the affected side for at least 20 hours per week in the 1 year before the clinical worsening of epicondylitis;\n2.  taking a fluoroquinolone antibiotic within the 14 days before the clinical worsening of epicondylitis;\n\n> Note: Examples of fluoroquinolone antibiotics include ciprofloxacin, moxifloxacin, norfloxacin and ofloxacin.\n\n1.  having spondyloarthritis at the time of the clinical worsening of epicondylitis;\n\n> Note: spondyloarthritis is defined in the Schedule 1 – Dictionary.\n\n1.  inability to obtain appropriate clinical management for epicondylitis.\n\n1.  Relationship to service\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    2.  The factors set out in subsections 9(5) to 9(9) apply only to material contribution to, or aggravation of, epicondylitis where the person's epicondylitis was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.  Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n1.  if a factor referred to in section 9 applies in relation to a person; and\n2.  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\nSchedule 1 \\- Dictionary\n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\nepicondylitis—see subsection 7(2).\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\nrelevant 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\n> Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\nspondyloarthritis means:\n\n(a) ankylosing spondylitis;\n\n(b) enteropathic spondyloarthropathy;\n\n(c) reactive arthritis; or\n\n(d) undifferentiated spondyloarthropathy.\n\nterminal 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\nVEA means the Veterans' Entitlements Act 1986.","sortOrder":0}],"analysis":{"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 2015 version (No. 8 of 2015) with updated medical evidence but does not expand beyond the traditional purpose of defining service connection factors for a specific medical condition. The structure follows the standard template used for all such instruments."},"complexity_factors":["Moderate cross-referencing between the main instrument and Schedule 1 (Dictionary)","Dual application framework — applies to two different Acts (VEA and MRCA) with different service definitions","Conditional logic requiring specific temporal relationships ('at least 1 hour per day, on more days than not, over a period of at least 3 months')","Medical terminology requiring definition (spondyloarthritis, fluoroquinolone, terminal event)","Distinction between 'clinical onset' and 'clinical worsening' with parallel but separate factor sets","Reference to external classification system (ICD-10-AM Tenth Edition) for coding purposes","Incorporation by reference of other Statements of Principles for related conditions"],"plain_english_summary":"This instrument updates the medical rules for deciding whether Australian veterans and defence members can get compensation for epicondylitis (tennis/golfer’s elbow), replacing the 2015 version and applying the \"balance of probabilities\" test. \n\nIt specifies the types of service‑related exposures and clinical factors that must be present for a condition to be accepted — affecting entitlement to pensions, treatment and rehabilitation — so meeting those connection criteria is central to successful claims."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2015 Statement of Principles (s4) and restates the criteria for associating epicondylitis and death from epicondylitis with relevant service (s7, s9). It adds or clarifies specific exposure thresholds and non‑mechanical risk factors (hand‑held mouse use, recent fluoroquinolone use, spondyloarthritis, and inability to obtain appropriate clinical management) and ties application to claims under the VEA and MRCA (s5, Schedule 1)."},"complexity_factors":["Technical medical definitions and cross‑references (definition of epicondylitis, ICD‑10‑AM note) — s7(2) and s7(4).","Multiple temporal and quantitative exposure thresholds (hours/day, weeks, and months) that determine causation — s9(1), s9(4) and s9(7).","Different standards for causation, worsening and material contribution/aggravation depending on timing of service and pre‑existing conditions — s10(1)–(2) and s9(5)–(9).","Incorporation of pharmacological and systemic disease factors (fluoroquinolone antibiotics, spondyloarthritis) alongside mechanical exposures — s9(3), s9(6) and Schedule 1.","Cross‑application with other Statements of Principles where factors refer to other injuries/diseases, creating layered interpretation — s11.","Legal application limited to claims under two separate Acts (VEA and MRCA), requiring administrative integration with entitlement processes — s5.","Inclusion of death via terminal events and defined list of terminal events introduces medico‑legal linkage complexity — s7(5) and Schedule 1.","Replaces a prior instrument (repeal), so administrators must map legacy cases to new criteria — s4."],"plain_english_summary":"This instrument, made by the Repatriation Medical Authority (s1 Authority), replaces the 2015 Statement and sets the medical criteria for linking epicondylitis (including tennis/golfer's elbow) and death from it to veterans' service. It applies to claims under the Veterans' Entitlements Act or the Military Rehabilitation and Compensation Act (s4, s5, s7).\n\nClaimants must show specified exposures — e.g. forceful plus repetitive or sustained forearm use (≥1 hour/day for ≥3 months), ≥20 hrs/week hand‑held mouse use, recent fluoroquinolone use, spondyloarthritis, or inability to obtain appropriate clinical management — to establish connection (s9; Schedule 1)."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-epicondylitis-balance-of-probabilities-no-6-of-2023","history":"/api/acts/statement-of-principles-concerning-epicondylitis-balance-of-probabilities-no-6-of-2023/history","analysis":"/api/acts/statement-of-principles-concerning-epicondylitis-balance-of-probabilities-no-6-of-2023/analysis","conflicts":"/api/acts/statement-of-principles-concerning-epicondylitis-balance-of-probabilities-no-6-of-2023/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-epicondylitis-balance-of-probabilities-no-6-of-2023/important-cases","documents":"/api/acts/statement-of-principles-concerning-epicondylitis-balance-of-probabilities-no-6-of-2023/documents"}}