{"id":"F2023L00019","name":"Statement of Principles concerning epicondylitis (Reasonable Hypothesis) (No. 5 of 2023)","slug":"statement-of-principles-concerning-epicondylitis-reasonable-hypothesis-no-5-of-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":103702,"registerId":"commonwealth-F2023L00019-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning epicondylitis (Reasonable Hypothesis) (No. 5 of 2023)","content":"![RMA Australian Government Coat of Arms](image.001.jpeg)\n\nStatement of Principles\n\nconcerning\n\nEPICONDYLITIS  \n(Reasonable Hypothesis)\n\n(No. 5 of 2023)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) 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\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.........................................6\n\n11 Factors referring to an injury or disease covered by another Statement of Principles.6\n\nSchedule 1 - Dictionary...............................................7\n\n1 Definitions................................................7\n\n  \n\n1.  Name\n\nThis is the Statement of Principles concerning epicondylitis (Reasonable Hypothesis) (No. 5 of 2023).\n\n1.  Commencement\n\nThis instrument commences on 23 January 2023.\n\n1.  Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n1.  Repeal\n\nThe Statement of Principles concerning epicondylitis No. 7 of 2015 (Federal Register of Legislation No. F2014L01784) made under subsection 196B(2) of the VEA is repealed.\n\n1.  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\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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that epicondylitis and death from epicondylitis 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\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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting epicondylitis or death from epicondylitis 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 4 weeks 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 6 months before the clinical onset of epicondylitis;\n2.  having a sudden alteration of loading pattern as specified for a continuous period of at least 1 hour, within the 3 days before the clinical onset of epicondylitis;\n\n> Note: having a sudden alteration of loading pattern as specified is defined in the Schedule 1 - Dictionary.\n\n1.  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 4 weeks 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 6 months before the clinical worsening of epicondylitis;\n2.  having a sudden alteration of loading pattern as specified for a continuous period of at least 1 hour, within the 3 days before the clinical worsening of epicondylitis;\n\n> Note: having a sudden alteration of loading pattern as specified is defined in the Schedule 1 - Dictionary.\n\n1.  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(6) to 9(11) 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(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\nSchedule 1 \\- Dictionary\n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\nepicondylitis—see subsection 7(2).\n\nhaving a sudden alteration of loading pattern as specified means suddenly increasing the frequency, duration or intensity of forceful and repetitive or sustained activities with the hand or forearm on the affected side by at least 100 percent and to a minimum intensity of at least 5 METs. Examples of such activities include using a rowing machine, carrying objects of at least 10 kilograms, vigorous gardening, using heavy power tools or carpentry;\n\n> Note: MET is defined in the Schedule 1 – Dictionary.\n\nMET 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\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\nrelevant 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\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 updates the specific medical criteria for epicondylitis based on current evidence but does not expand beyond the original purpose of determining service-related causation for this specific condition. The structure mirrors previous versions with the standard 'reasonable hypothesis' framework."},"complexity_factors":["Moderate cross-referencing between main text and Schedule 1 Dictionary (12 defined terms)","Nested conditional logic in section 9 with parallel structures for 'clinical onset' vs 'clinical worsening' (6 factors each, plus one standalone factor)","Technical medical terminology requiring definition (ICD-10-AM codes, METs, spondyloarthritis subtypes)","Specific quantitative thresholds throughout (1 hour/day, 4 weeks, 20 hours/week, 6 months, 100% increase, 5 METs, 14 days, 3 days)","Exception to general rule in section 10(2) limiting application of worsening factors to pre-existing conditions","Incorporation by reference of other Statements of Principles in section 11"],"plain_english_summary":"This instrument replaces the 2015 guidance with updated medical evidence setting when epicondylitis (tennis/golfer’s elbow) can be linked to service under the lower “reasonable hypothesis” test. It identifies the types of work, sudden overexertion, certain antibiotics, pre-existing inflammatory arthritis, and failures of care that can support a service connection.\n\nIt affects veterans, peacekeepers, and current/former defence members (and their families for death claims) seeking treatment, income support, or lump‑sum compensation from the Department of Veterans’ Affairs."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the prior Statement of Principles No. 7 of 2015 (section 4) and substitutes a new set of criteria. The replacement specifies precise exposure thresholds (section 9(1)–9(2)), a defined sudden-loading metric using METs (Schedule), a 14‑day fluoroquinolone window (section 9(4)), explicit treatment of clinical worsening as well as onset (section 9(6)–9(11)), inclusion of death via a defined terminal event (section 7(3); Schedule), and continued application to claims under the VEA and MRCA (section 5). These additions and definitional clarifications indicate a changed scope and evidentiary framing compared with the instrument it repeals."},"complexity_factors":["Multiple, specific exposure thresholds and timeframes that claimants must establish (e.g. ≥1 hour/day on more days than not for ≥4 weeks; 20 hours/week mouse use for 6 months; sudden alteration ≥100% for ≥1 hour within 3 days) (section 9; Schedule).","Separate and repeated criteria for both clinical onset and clinical worsening of epicondylitis, increasing evidentiary permutations (section 9(1)–9(11)).","Inclusion of non-mechanical triggers requiring recent medical history (fluoroquinolone antibiotics within 14 days) and comorbid diagnoses (spondyloarthritis) (sections 9(4), 9(6), 9(10); Schedule).","Technical definitions that affect application (MET unit, ‘sudden alteration of loading pattern’, terminal event, ICD‑10‑AM note), requiring clinical and occupational interpretation (Schedule; section 7(2)–(3)).","Requirement that any factor be related to the person’s relevant service under the VEA/MRCA, and limits on how factors apply to material contribution or aggravation when pre-existing disease existed (section 10(1)–(2); section 5).","Cross-reference rule: factors that point to another injury/disease use whatever Statement of Principles governs that condition, adding inter-instrument dependence (section 11).","Repeal and replacement of the 2015 statement introduces legal transition considerations for ongoing claims (section 4).","Decision-making and evidentiary burden rest on administrative application of medical-scientific views by the Repatriation Medical Authority and claim processes under statute, which can require synthesis of clinical, occupational and pharmaceutical evidence (section 8; section 5)."],"plain_english_summary":"Sets the medical criteria used to decide whether epicondylitis (tennis/golfer’s elbow) is reasonably connected to a veteran’s service for claims under the VEA and MRCA. It lists specific exposure and medical triggers (for example, forceful/repetitive or sustained arm use, 20 hours/week mouse use, sudden increased loading, recent fluoroquinolone use, or concurrent spondyloarthritis), applies to both clinical onset and worsening, and replaces the earlier 2015 Statement of Principles."},"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-reasonable-hypothesis-no-5-of-2023","history":"/api/acts/statement-of-principles-concerning-epicondylitis-reasonable-hypothesis-no-5-of-2023/history","analysis":"/api/acts/statement-of-principles-concerning-epicondylitis-reasonable-hypothesis-no-5-of-2023/analysis","conflicts":"/api/acts/statement-of-principles-concerning-epicondylitis-reasonable-hypothesis-no-5-of-2023/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-epicondylitis-reasonable-hypothesis-no-5-of-2023/important-cases","documents":"/api/acts/statement-of-principles-concerning-epicondylitis-reasonable-hypothesis-no-5-of-2023/documents"}}