{"id":"F2024L00223","name":"Statement of Principles concerning hallux valgus (Balance of Probabilities) (No. 26 of 2024)","slug":"statement-of-principles-concerning-hallux-valgus-balance-of-probabilities-no-26-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442295,"registerId":"F2024L00223-fast-fetch-1775957344384","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning hallux valgus (Balance of Probabilities) (No. 26 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\nHALLUX VALGUS (Balance of Probabilities)\n\n(No. 26 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 22 February 2024. \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 hallux valgus (Balance of Probabilities) (No. 26 of 2024).\n\n2 Commencement\n\n This instrument commences on 26 March 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 hallux valgus (Balance of Probabilities) (No. 99 of 2015) (Federal Register of Legislation No. F2015L01335) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 hallux valgus and death from hallux valgus.\n\nMeaning of hallux valgus\n\n(2) For the purposes of this Statement of Principles:\n\nhallux valgus means a symptomatic deformity of the foot, where\n\nthe great toe is deviated laterally at the first metatarsophalangeal joint,\n\nand often causing a bony prominence or bunion to develop over the\n\nmedial aspect of the first metatarsal head and neck.\n\nDeath from hallux valgus\n\n(3) For the purposes of this Statement of Principles, hallux valgus, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's hallux valgus.\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 hallux valgus and death from hallux valgus 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, hallux valgus or death from hallux valgus is connected with the circumstances of a person's relevant service:\n\n(1) wearing footwear that causes substantial lateral deviation of the great toe of the affected foot, for at least 7 hours per day, on more days than not for a period of at least 3 years before the clinical onset or clinical worsening of hallux valgus;\n\n(2) having rheumatoid arthritis involving the first metatarsophalangeal joint of the affected foot before the clinical onset or clinical worsening of hallux valgus;\n\n(3) having gout or calcium pyrophosphate deposition disease (also known as pseudogout) involving the first metatarsophalangeal joint of the affected foot before the clinical onset or clinical worsening of hallux valgus;\n\n(4) having acquired loss of one or more of the phalanges of the second toe or the second metatarsal head of the affected foot, before the clinical onset or clinical worsening of hallux valgus;\n\n(5) having a tumour involving the first metatarsophalangeal joint or second metatarsal bone of the affected foot at the time of the clinical onset or clinical worsening of hallux valgus;\n\n(6) having trauma to the affected forefoot that results in:\n\n(a) disruption of the first metatarsophalangeal joint capsule;\n\n(b) disruption of the sesamoid complex of the hallux;\n\n(c) fracture of the medial side of the first proximal phalanx base;\n\n(d) fracture resulting in shortening of the second metatarsal;\n\n(e) tarso-metatarsal joint complex injury; or\n\n(f) tear of the medial collateral ligament of the first metatarsophalangeal joint;\n\nwithin the 3 years before the clinical onset or clinical worsening of hallux valgus;\n\nNote: trauma to the affected forefoot is defined in the Schedule 1 - Dictionary.\n\n(7) inability to obtain appropriate clinical management for hallux valgus before the clinical worsening of hallux valgus.\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, hallux valgus where the person's hallux valgus 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 hallux valgus—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 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 trauma to the affected forefoot means a discrete event involving the application of significant physical force to or through the affected forefoot, that causes:\n\n(a) damage to the forefoot; and\n\n(b) the development, within 24 hours of the event occurring, of symptoms and signs of pain, tenderness and either altered mobility or range of movement of the forefoot. 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(c) 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 that forefoot has occurred and that medical intervention involves one of the following:\n\n(i) immobilisation of the forefoot in a boot or similar external agent;\n\n(ii) injection of a corticosteroid or local anaesthetic into that forefoot; or\n\n(iii) surgery to that forefoot.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles concerning hallux valgus (No. 99 of 2015) (s 4) and replaces it with the 2024 Statement, which commences 26 March 2024 (s 2). It applies to claims under section 120B of the VEA or section 339 of the MRCA (s 5). The new instrument restates the medical definition of hallux valgus and death from it (s 7), specifies the factors that must exist to connect the condition to relevant service (s 9), requires those factors be related to relevant service (s 10), and cross-references other Statements where applicable (s 11)."},"complexity_factors":["Clear, limited subject matter: single condition (hallux valgus) with definition (s 7).","List of discrete causative/contributory factors with specific temporal thresholds (s 9(1) and subparagraphs).","Requirement that any listed factor be related to the person’s relevant service (s 10(1)) creates an evidentiary link to be proved.","Distinction between clinical onset and clinical worsening and limited application of ‘worsening’ (s 10(2)) requiring prior existence of condition.","Interplay with other Statements of Principles where factors invoke other conditions (s 11) adds cross-referencing and potential reliance on other instruments.","Detailed definitions affecting interpretation (e.g. ‘trauma to the affected forefoot’, ‘terminal event’, and ‘relevant service’) in Schedule 1 introduce precise medical and service-bound triggers.","Operationalisation depends on medical evidence ‘on the balance of probabilities’ (s 8), placing weight on available scientific evidence and clinical records.","Some factor formulations (eg. 'footwear that causes substantial lateral deviation' in s 9(1)) require qualitative clinical judgment, raising potential for fact-specific disputes."],"plain_english_summary":"This Statement sets the medical criteria used to decide whether hallux valgus (bunions) — and death partly caused by it — are connected to a person's military or repatriation service for compensation claims. It affects veterans and service members claiming under the VEA or MRCA by listing a medical definition, required contributing factors (for example, certain footwear use, arthritis, trauma), time limits and the requirement that those factors be shown to relate to the person's relevant service."},"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 RMA Statement of Principles instrument that replaces a 2019 version (No. 99 of 2015). It maintains the established scope of determining medical causation for a specific condition under veterans' compensation law. No expansion beyond the original purpose of providing medical-scientific criteria for claims determination."},"complexity_factors":["Moderate cross-referencing: Links to definitions in Schedule 1 and references to other Statements of Principles for related conditions","Conditional logic with time limits: Factor (1) requires '7 hours per day, on more days than not, for at least 3 years'; Factor (6) requires trauma 'within 3 years before' onset","Nested definitions: 'trauma to the affected forefoot' is a multi-part definition with 3 cumulative elements and a 3-part exception for medical intervention","Dual legislative framework: Must operate under both VEA and MRCA with different service definitions","7 distinct factors with varying applicability — some apply to onset, some to worsening, some to both","Specific anatomical terminology requiring medical knowledge (metatarsophalangeal joint, sesamoid complex, etc.)"],"plain_english_summary":"This instrument sets the Repatriation Medical Authority’s medical rules for linking hallux valgus (bunion) to Australian military service, governing claims under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act. It requires evidence of specified service‑related medical factors to establish causation or aggravation, replaces the 2015 statement, and narrows the scientific thresholds so bunion claims are assessed more consistently."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-hallux-valgus-balance-of-probabilities-no-26-of-2024","history":"/api/acts/statement-of-principles-concerning-hallux-valgus-balance-of-probabilities-no-26-of-2024/history","analysis":"/api/acts/statement-of-principles-concerning-hallux-valgus-balance-of-probabilities-no-26-of-2024/analysis","conflicts":"/api/acts/statement-of-principles-concerning-hallux-valgus-balance-of-probabilities-no-26-of-2024/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-hallux-valgus-balance-of-probabilities-no-26-of-2024/important-cases","documents":"/api/acts/statement-of-principles-concerning-hallux-valgus-balance-of-probabilities-no-26-of-2024/documents"}}