{"id":"F2023L01446","name":"Statement of Principles concerning gluteal tendinopathy (Reasonable Hypothesis) (No. 94 of 2023)","slug":"statement-of-principles-concerning-gluteal-tendinopathy-reasonable-hypothesis-no-94-of-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442154,"registerId":"F2023L01446-fast-fetch-1775957237225","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning gluteal tendinopathy (Reasonable Hypothesis) (No. 94 of 2023)","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\nGLUTEAL TENDINOPATHY (Reasonable Hypothesis)\n\n(No. 94 of 2023)\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 25 October 2023.\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 Terence Campbell AM
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 gluteal tendinopathy (Reasonable Hypothesis) (No. 94 of 2023).\n\n2 Commencement\n\n This instrument commences on 28 November 2023.\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 trochanteric bursitis and gluteal tendinopathy No. 45 of 2015 (Federal Register of Legislation No. F2015L00010) made under subsections 196B(2) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 gluteal tendinopathy and death from gluteal tendinopathy.\n\nMeaning of gluteal tendinopathy\n\n(2) For the purposes of this Statement of Principles, gluteal tendinopathy means a symptomatic inflammatory or degenerative disease of the gluteus medius or gluteus minimus tendons at or near their insertion into the greater trochanter of the hip.\n\nNote: Clinical manifestations of gluteal tendinopathy typically include pain and tenderness in the region of the lateral hip or buttock that usually worsens with physical activity. Gluteal tendinopathy can be associated with degenerative tendon tears.\n\n(3) While gluteal tendinopathy attracts ICD‑10‑AM code M76.0, in applying this Statement of Principles the meaning of gluteal tendinopathy is that given in subsection (2).\n\n(4) 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 gluteal tendinopathy\n\n(5) For the purposes of this Statement of Principles, gluteal tendinopathy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's gluteal tendinopathy.\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 gluteal tendinopathy and death from gluteal tendinopathy 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 gluteal tendinopathy or death from gluteal tendinopathy with the circumstances of a person's relevant service:\n\n(1) running or jogging an average of at least 30 kilometres per week for the 4 weeks before the clinical onset or clinical worsening of gluteal tendinopathy;\n\n(2) undertaking weight bearing exercise involving repeated activity of the hip on the affected side for:\n\n(a) a minimum intensity of 5 METS; and\n\n(b) for at least 4 hours per week; and\n\nfor at least the 4 weeks before the clinical onset or clinical worsening of gluteal tendinopathy;\n\nNote 1: Examples of weight bearing exercise involving repeated activity of the hip at a minimum intensity of 5 METS include marching, sustained brisk walking, climbing stairs, playing football, and dancing.\n\nNote 2: MET is defined in the Schedule 1 - Dictionary.\n\n(3) increasing the frequency, duration or intensity of activity involving the hip on the affected side:\n\n(a) by at least 100 percent; and\n\n(b) to a minimum intensity of 5 METs; and\n\n(c) for at least 2 hours per day;\n\nwithin the one week before the clinical onset or clinical worsening of gluteal tendinopathy;\n\nNote: MET is defined in the Schedule 1 - Dictionary.\n\n(4) having direct trauma to the affected tendon within the 4 weeks before the clinical onset or clinical worsening of gluteal tendinopathy;\n\nNote: direct trauma to the affected tendon is defined in the Schedule 1 – Dictionary.\n\n(5) having surgery to the hip of the affected side within the 4 weeks before the clinical onset or clinical worsening of gluteal tendinopathy;\n\n(6) having a systemic inflammatory disease before the clinical onset or clinical worsening of gluteal tendinopathy;\n\nNote: systemic inflammatory disease is defined in the Schedule 1 - Dictionary.\n\n(7) having a significantly abnormal gait for at least the 4 weeks before the clinical onset or clinical worsening of gluteal tendinopathy;\n\n(8) being obese at the time of the clinical onset or clinical worsening of gluteal tendinopathy;\n\nNote: being obese is defined in the Schedule 1 – Dictionary.\n\n(9) inability to obtain appropriate clinical management for gluteal tendinopathy before the clinical worsening of gluteal tendinopathy.\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, gluteal tendinopathy where the person's gluteal tendinopathy 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\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 defined in the Schedule 1 – Dictionary.\n\n BMI means W/H2 where:\n\n W is the person's weight in kilograms; and\n\n H is the person's height in metres.\n\n direct trauma to the affected tendon means a discrete event involving the application of significant physical force to the affected tendon, that causes:\n\n(a) the development of symptoms and signs of pain and tenderness, and either altered mobility or range of movement of the hip. In the case of sustained unconsciousness or the masking of pain by analgesic medication, these symptoms and signs must appear on return to consciousness or the withdrawal of the analgesic medication; and\n\n(b) the persistence of these symptoms and signs for a period of at least 7 days following their onset, save for where medical intervention for the trauma to the affected tendon has occurred and that medical intervention involves one of the following:\n\n(i) immobilisation of the hip by splinting or similar external agent;\n\n(ii) injection of a corticosteroid or local anaesthetic into the hip; or\n\n(iii) surgery to the hip.\n\n gluteal tendinopathy—see subsection 7(2).\n\n MET 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\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 systemic inflammatory disease means:\n\n(a) rheumatoid arthritis;\n\n(b) polymyalgia rheumatica;\n\n(c) ankylosing spondylitis;\n\n(d) enteropathic spondyloarthropathy (arthritis associated with inflammatory bowel disease);\n\n(e) psoriatic arthropathy;\n\n(f) reactive arthritis; or\n\n(g) undifferentiated spondyloarthropathy.\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":true,"description":"This instrument narrows scope compared to its predecessor. The 2015 Statement covered both 'trochanteric bursitis and gluteal tendinopathy' as combined conditions. This 2023 instrument repeals that combined determination and establishes gluteal tendinopathy as a standalone condition with its own specific criteria. The scope is now more focused on the tendon pathology specifically, rather than the broader bursitis/tendinopathy complex, and includes updated medical definitions reflecting current clinical understanding."},"complexity_factors":["Multiple nested definitions requiring cross-referencing (e.g., 'direct trauma' defined with 3 sub-conditions and a 7-day persistence requirement with exceptions)","Technical medical thresholds: MET calculations (metabolic equivalents), BMI formulas, specific timeframes (4 weeks, 7 days, 1 week)","Conditional logic in factor (3) requiring simultaneous satisfaction of percentage increase (100%), intensity floor (5 METs), and duration minimum (2 hours/day)","Dual application framework — applies to two different Acts (VEA and MRCA) with different service categories","Incorporation by reference to external medical classification (ICD-10-AM Tenth Edition)","Distinguishing between 'clinical onset' and 'clinical worsening' with different rules for each","Section 11 creates dynamic referencing to other Statements of Principles that may change over time"],"plain_english_summary":"This instrument sets medical rules for veterans and current/former Australian Defence Force members to claim compensation for gluteal tendinopathy, using a lower “reasonable hypothesis” test to link the condition to service. It identifies nine service‑related factors (e.g., heavy running, sudden activity increase, trauma, surgery, obesity, inflammatory disease, disrupted gait, lack of timely treatment) that can make a claim succeed. It replaces a 2015 combined determination and clarifies access to compensation and rehabilitation for service‑related hip tendon injury."},"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"},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles No.45 of 2015 (s.4). The previous instrument covered 'trochanteric bursitis and gluteal tendinopathy'; the current instrument addresses gluteal tendinopathy (and death from it) only (s.7). It applies to claims under section 120A of the VEA and section 338 of the MRCA (s.5), so claim scope is tied to those statutory claim pathways."},"complexity_factors":["Precise medical definition and ICD-10-AM cross-reference for gluteal tendinopathy (s.7(2)–(4))","Multiple numeric exposure thresholds and activity metrics to establish causation (e.g. 30 km/week running; 5 METS; 100% increase to ≥5 METS and ≥2 hours/day) (s.9(1)–(3))","Short, specific temporal windows for onset or worsening (chiefly 4 weeks and 1 week) creating tight evidentiary timing requirements (s.9)","Objective anthropometric and physiological measures required (BMI ≥30; MET definition) that require calculation or expert evidence (Schedule 1)","Inclusion of death via contribution to a terminal event and defined list of terminal events (s.7(5); Schedule 1)","Requirement that any listed factor be related to the person's 'relevant service' and distinction between material contribution/ worsening versus arising out of service (s.10(1)–(2))","Interaction with and deference to other Statements of Principles where factors overlap, creating cross-instrument dependencies (s.11)","Repeal of the prior 2015 Statement (which covered trochanteric bursitis and gluteal tendinopathy) — changes scope and precedent (s.4)","Administrative standard is the RMA's 'reasonable hypothesis' view based on medical-scientific evidence, leaving interpretive judgment to the Authority (s.8)","Claim-application constraint to specific statutory claims under the VEA and MRCA, which limits who may rely on the Statement (s.5)"],"plain_english_summary":"This Statement of Principles sets the medical criteria the Repatriation Medical Authority uses to decide whether gluteal tendinopathy (and death from it) can be reasonably linked to a veteran’s relevant service for VEA and MRCA claims. It replaces a prior 2015 Statement. It matters because meeting one of the listed clinical, activity or injury factors (e.g. exercise thresholds, trauma, surgery, systemic disease, obesity) is the minimum required to raise a 'reasonable hypothesis' for entitlement."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-gluteal-tendinopathy-reasonable-hypothesis-no-94-of-2023","history":"/api/acts/statement-of-principles-concerning-gluteal-tendinopathy-reasonable-hypothesis-no-94-of-2023/history","analysis":"/api/acts/statement-of-principles-concerning-gluteal-tendinopathy-reasonable-hypothesis-no-94-of-2023/analysis","conflicts":"/api/acts/statement-of-principles-concerning-gluteal-tendinopathy-reasonable-hypothesis-no-94-of-2023/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-gluteal-tendinopathy-reasonable-hypothesis-no-94-of-2023/important-cases","documents":"/api/acts/statement-of-principles-concerning-gluteal-tendinopathy-reasonable-hypothesis-no-94-of-2023/documents"}}