{"id":"F2024L01042","name":"Statement of Principles concerning fracture (Balance of Probabilities) (No. 63 of 2024)","slug":"statement-of-principles-concerning-fracture-balance-of-probabilities-no-63-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442534,"registerId":"F2024L01042-fast-fetch-1775957509843","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning fracture (Balance of Probabilities) (No. 63 of 2024)","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\nFRACTURE (Balance of Probabilities)\n\n(No. 63 of 2024)\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 20 August 2024.\n\n \n\n \n\n \n\n \n\n \n\n|
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Professor Terence Campbell AM
Chairperson
by and on behalf of
The Repatriation Medical Authority |\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 fracture (Balance of Probabilities) (No. 63 of 2024).\n\n2 Commencement\n\n This instrument commences on 24 September 2024.\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 fracture No. 95 of 2015 (Federal Register of Legislation No. F2015L01343) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 fracture and death from fracture.\n\nMeaning of fracture\n\n(2) For the purposes of this Statement of Principles, fracture:\n\n(a) means an acquired break of bone as a result of an applied force that ordinarily would cause bone breakage in a healthy bone; and\n\n(b) includes:\n\n(i) acute vascular shock, acute compartment syndrome, or fat embolism resulting from the fractured bone;\n\n(ii) avulsion, crush, comminuted, burst, or blowout fracture;\n\n(iii) closed or compound/open fracture;\n\n(iv) fracture of bone contiguous with an orthopaedic implant; and\n\n(v) growth plate fractures;\n\n(vi) periosteal, muscular, fascial, skin, nerve or vascular damage directly caused by the displaced fractured bone;\n\n(vii) stress fracture of the fatigue type;\n\n(viii) torsion or spiral fracture; and\n\n(ix) wound infection as a result of penetration of the skin by bony fracture fragments (compound fracture);\n\n(c) excludes:\n\n(i) pathological fracture;\n\n(ii) bone stress injury/bone marrow oedema not being a stress fracture;\n\n(iii) stress fracture of the insufficiency type;\n\n(iv) osteonecrosis;\n\n(v) periostitis;\n\n(vi) fracture of teeth;\n\n(vii) fracture of cartilage;\n\n(viii) fracture of an orthopaedic implant including a screw, nail, fixation plate or prosthesis; and\n\n(ix) spondylolysis.\n\nNote: Clinical worsening could include fracture non-union but not an additional fracture. An additional fracture would require further invocation of the fracture statement of principles.\n\nDeath from fracture\n\n(3) For the purposes of this Statement of Principles, fracture, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's fracture.\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 fracture and death from fracture 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, fracture or death from fracture is connected with the circumstances of a person's relevant service:\n\n(1) having significant physical force applied to or through the affected bone at the time of clinical onset;\n\n(2) for stress fracture only, having significant repetitive loading stress to the affected bone prior to clinical onset;\n\nNote: Examples of situations involving significant repetitive loading stress includes military training, weight training, athletics or running.\n\n(3) for stress fracture only, having significant chronic repetitive loading stress to the affected bone due to abnormal force intensity or direction of application, at the time of clinical onset;\n\nNote: An example of chronic repetitive stress due to changed force intensity or force direction would be an uncorrected substantial leg length inequality, or a substantial valgus or varus joint malalignment.\n\n(4) smoking at least 5 cigarettes per day, or the equivalent thereof in other tobacco products, during treatment for fracture prior to fracture non-union;\n\nNote 1: One gram of tobacco is considered to be equivalent to one cigarette.\n\nNote 2: Fracture non-union is considered to be a clinical worsening of the fracture.\n\n(5) having diabetes mellitus at the time of the fracture non-union;\n\nNote: Fracture non-union is considered to be a clinical worsening of the fracture.\n\n(6) inability to obtain appropriate clinical management for fracture before clinical worsening.\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, fracture where the person's fracture 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 fracture—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 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 is a standard replacement of an expired Statement of Principles under the Veterans' Entitlements Act framework. It maintains the same scope as its 2015 predecessor and operates within the established statutory scheme for determining service-related injury claims. The content reflects the typical structure and approach of Repatriation Medical Authority instruments."},"complexity_factors":["Multiple nested definitions with inclusions and exclusions (subsection 7(2) has 9 inclusions and 9 exclusions for 'fracture')","Conditional logic with factor-specific limitations (factors 2 and 3 apply 'for stress fracture only')","Cross-referencing mechanism in section 11 that incorporates other Statements of Principles by reference","Dual legislative framework application (VEA and MRCA with different service definitions)","Technical medical terminology requiring clinical interpretation ('avulsion', 'comminuted', 'fat embolism', 'valgus or varus joint malalignment')","Temporal complexity in factor 4 (smoking 'during treatment for fracture prior to fracture non-union')","Distinction between clinical onset and clinical worsening concepts","Defined terms in Schedule 1 that reference other defined terms creating definitional chains"],"plain_english_summary":"This instrument replaces the 2015 fractures rulebook and sets when a fracture is “more likely than not” service-related for claims under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act. It tells the Repatriation Medical Authority and DVA decision-makers how to link fractures to service for current and former ADF members.\n\nCompensation hinges on specific causal pathways—acute force, repetitive/stress loading or abnormal mechanics, treatment-complicating factors (heavy smoking, diabetes) or inadequate care—otherwise fractures aren’t accepted as service-related."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2015 Statement (s4) and restates what counts as fracture and death from fracture (s7), adding or clarifying specific inclusions and exclusions (s7(2)(b)–(c)), explicitly listing contributory and clinical-worsening factors (s9) and tying those factors to timing of relevant service (s10). It therefore changes scope by redefining covered fracture types, adding specified causal triggers (e.g. smoking threshold, diabetes, lack of appropriate management), and by cross‑referencing other Statements where applicable (s11)."},"complexity_factors":["Multiple technical medical definitions and carve-outs for different fracture types and related conditions (inclusions and exclusions in s7(2)).","Separate treatment of stress fractures with distinct causal tests (s9(2)–(3)).","Inclusion of clinical-worsening concepts (fracture non-union) that depend on timing of treatment and comorbidities (s7 note; s9(4)–(5); s10(2)).","Non-medical contributory factors listed as causative (smoking threshold, diabetes) that create binary evidentiary triggers (s9(4)–(5)).","Requirement that any listed factor be related to relevant service, linking medical facts to service history for entitlement (s10(1)).","Cross-reference to other Statements of Principles where factors invoke other injuries/diseases, creating interdependence (s11).","Statutory context and application limited to claims under specific Acts and sections (authority s3; application s5).","Repeal of the prior instrument and replacement structure that alters prior scope and precedent (s4).","Use of the civil standard of proof (‘balance of probabilities’) as the decision threshold (title and s8)."],"plain_english_summary":"This instrument replaces the 2015 Statement and sets the medical-legal test for when a fracture (or death contributed to by a fracture) is connected to a person’s VEA or MRCA relevant service. It defines what counts as a fracture (and what is excluded), then lists specific factors — e.g. significant force or repetitive loading, smoking, diabetes, or lack of appropriate treatment — that must be present, on the balance of probabilities, to establish a service connection for claims by veterans or serving members."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-fracture-balance-of-probabilities-no-63-of-2024","history":"/api/acts/statement-of-principles-concerning-fracture-balance-of-probabilities-no-63-of-2024/history","analysis":"/api/acts/statement-of-principles-concerning-fracture-balance-of-probabilities-no-63-of-2024/analysis","conflicts":"/api/acts/statement-of-principles-concerning-fracture-balance-of-probabilities-no-63-of-2024/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-fracture-balance-of-probabilities-no-63-of-2024/important-cases","documents":"/api/acts/statement-of-principles-concerning-fracture-balance-of-probabilities-no-63-of-2024/documents"}}