{"id":"F2024L01041","name":"Statement of Principles concerning fracture (Reasonable Hypothesis) (No. 62 of 2024)","slug":"statement-of-principles-concerning-fracture-reasonable-hypothesis-no-62-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442533,"registerId":"F2024L01041-fast-fetch-1775957509822","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning fracture (Reasonable Hypothesis) (No. 62 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 (Reasonable Hypothesis)\n\n(No. 62 of 2024)\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 20 August 2024.\n\n \n\n \n\n \n\n \n\n \n\n|
|\n| --- |\n|
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 (Reasonable Hypothesis) (No. 62 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning fracture No. 94 of 2015 (Federal Register of Legislation No. F2015L01340) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that fracture and death from fracture 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 fracture or death from fracture 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) having osteoporosis 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(7) having vitamin D deficiency, with a serum 25(OH)D level of less than 50 nanomoles per litre 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(8) having a Body Mass Index (BMI) of 40 or greater at the time of the fracture non-union;\n\nNote 1: BMI is defined in the Schedule 1 - Dictionary.\n\nNote 2: Fracture non-union is considered to be a clinical worsening of the fracture.\n\n(9) 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(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 BMI means W/H2 where:\n\n (a) W is the person's weight in kilograms; and\n\n (b) H is the person's height in metres.\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) 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 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 existing Statement of Principles (No. 94 of 2015). The scope remains consistent with the original intent — establishing medical criteria for linking fractures to military service. The structure follows the standard template for Repatriation Medical Authority instruments with definitions, factors, and application provisions. No significant scope creep is evident; it updates medical understanding and formatting without expanding beyond the original purpose of determining compensation eligibility for service-related fractures."},"complexity_factors":["Multiple defined terms in Schedule 1 (BMI, MRCA, VEA, relevant service, terminal event, fracture itself)","Nested definitions — 'fracture' defined in section 7(2) with 9 inclusions and 9 exclusions","Conditional logic with factor-specific limitations (factors 2 and 3 apply 'for stress fracture only')","Cross-references to other Statements of Principles in section 11","Clinical worsening provisions that apply differently depending on when the fracture originated (section 10(2))","Specific quantitative thresholds (5 cigarettes/day, BMI 40, vitamin D <50 nmol/L)","Dual legislative framework application (VEA and MRCA)"],"plain_english_summary":"This instrument replaces the 2015 fractures rulebook and sets when veterans, current and former defence members and peacekeepers can claim compensation for service-related bone fractures — including stress fractures, complications, and deaths from those complications. \n\nClaims proceed if there is a “reasonable hypothesis” linking the fracture to service and specified contributing factors; it excludes pathological and dental fractures and broken implants."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument repeals the earlier 2015 Statement of Principles for fracture (section 4) and restates the matters it covers (fracture and death from fracture). The text does not expressly broaden or narrow the class of injuries or the categories of service to which it applies; on its face the scope remains fracture-related claims under the VEA and MRCA (section 5 and Schedule definitions)."},"complexity_factors":["Detailed medical inclusions and exclusions for 'fracture' (subsection 7(2)) creating clinical interpretation needs.","Different tests for acute fractures versus stress fractures (sections 9(1)–9(3)), requiring distinct factual and expert evidence.","Numeric clinical thresholds (smoking ≥5/day; serum 25(OH)D <50 nmol/L; BMI ≥40) demand precise measurement and temporal proof at times of non‑union (sections 9(4), 9(7), 9(8)).","Reference to 'clinical worsening' and 'fracture non‑union' as qualification points introduces temporal and causation complexity (notes to section 7 and sections 9(4)–9(9)).","Legal standard of a 'reasonable hypothesis' underpins decision‑making and evidential sufficiency, requiring evaluative judgment rather than bright‑line rules (section 9).","Cross‑reference and interaction with other Statements of Principles where factors overlap (section 11), creating secondary dependencies on other instruments.","Application limited to claims under two Acts (VEA and MRCA) and to 'relevant service' definitions, so administrative scope depends on statutory eligibility (section 5; Schedule definitions).","Repeal of the prior 2015 instrument requires administrative transition and comparison to prior criteria (section 4)."],"plain_english_summary":"This Statement of Principles sets the medical criteria the Repatriation Medical Authority uses to decide when a fracture (or death contributed to by a fracture) can reasonably be linked to a veteran’s or service member’s relevant service. It applies to claims under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act and replaces the prior 2015 fracture statement (s3, s5). \n\nIt lists specific exposure and clinical risk factors — force or repetitive loading, and thresholds such as smoking ≥5 cigarettes/day, vitamin D <50 nmol/L, BMI ≥40, diabetes, osteoporosis, or inadequate management — that, if present, raise a reasonable hypothesis for entitlement and shape evidentiary requirements."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-fracture-reasonable-hypothesis-no-62-of-2024","history":"/api/acts/statement-of-principles-concerning-fracture-reasonable-hypothesis-no-62-of-2024/history","analysis":"/api/acts/statement-of-principles-concerning-fracture-reasonable-hypothesis-no-62-of-2024/analysis","conflicts":"/api/acts/statement-of-principles-concerning-fracture-reasonable-hypothesis-no-62-of-2024/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-fracture-reasonable-hypothesis-no-62-of-2024/important-cases","documents":"/api/acts/statement-of-principles-concerning-fracture-reasonable-hypothesis-no-62-of-2024/documents"}}