{"id":"F2024L01052","name":"Statement of Principles concerning ingrown nail (Balance of Probabilities) (No. 73 of 2024)","slug":"statement-of-principles-concerning-ingrown-nail-balance-of-probabilities-no-73-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442541,"registerId":"F2024L01052-fast-fetch-1775957517919","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning ingrown nail (Balance of Probabilities) (No. 73 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![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nINGROWN NAIL  (Balance of Probabilities)\n\n(No. 73 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 \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM             \n\nChairperson                                                         \n\nby and on behalf of                                                         \n\nThe Repatriation Medical Authority\n\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\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning ingrown nail (Balance of Probabilities) (No. 73 of 2024).\n\n1.                Commencement\n\n\n              This instrument commences on 24 September 2024.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning ingrowing nail No. 107 of 2015 (Federal Register of Legislation No. F2015L01327) made under subsection 196B(3) of the VEA is repealed.\n\n1.                Application\n\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\n1.                Definitions\n\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 ingrown nail and death from ingrown nail.\n\n\nMeaning of ingrown nail\n\n1.           For the purposes of this Statement of Principles, ingrown nail means a condition in which the nail plate penetrates the soft tissue of the adjacent nail fold resulting in inflammation and pain (includes retronychia).\n2.           While ingrown nail attracts ICD‑10‑AM code L60.0, in applying this Statement of Principles the meaning of ingrown nail is that given in subsection (2).\n3.           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\n\nDeath from ingrown nail\n\n1.           For the purposes of this Statement of Principles, ingrown nail, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's ingrown nail.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that ingrown nail and death from ingrown nail 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\n1.                Factors that must exist\n\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, ingrown nail or death from ingrown nail is connected with the circumstances of a person's relevant service:\n\n1.           having an acquired deformity of the affected digit which causes the nail to be pushed into the proximate soft tissue at the time of clinical onset;\n\n\nNote:  Examples of such a deformity include, but are not limited to hallux valgus, subungual exostosis, or deformity caused by systemic disease.\n\n1.           having an injury to the affected nail or the affected nail bed, within the 6 months before the clinical onset or clinical worsening;\n2.           Being treated with;\n  1.           an oral retinoid;\n  2.           indinavir;\n  3.           an epidermal growth factor inhibitor;\n  4.           cyclosporine (cyclosporin);\n\n\nWithin the 6 months before clinical onset or clinical worsening;\n\n \n\n1.           having excessive trimming of the affected toenail or rounding the corners of the affected toenail rather than cutting the nail straight across the top within 14 days before clinical onset or clinical worsening;\n2.           wearing footwear that causes compression of the toes or pressure on the affected toenail. This includes but is not limited to footwear that is too narrow or too short, or has inadequate depth in the toe box on the affected foot, for at least 8 hours within the 4 weeks before clinical onset or clinical worsening;\n\n\n1.           having hyperhidrosis affecting the feet within the 7 days before the clinical onset or clinical worsening;\n2.           having diabetes mellitus at the time of clinical onset or clinical worsening;\n3.           having a fungal infection involving the affected nail within the one year before clinical onset or clinical worsening;\n4.           inability to obtain appropriate clinical management for ingrown nail before clinical worsening.\n\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 clinical worsening aspect of factors set out in section 9 apply only to material contribution to, or aggravation of, ingrown nail where the person's ingrown nail 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\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(3) of the VEA;\n\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                               ingrown nail—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":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles (No.107 of 2015) (s.4) and substitutes a new set of definitions and factor-based criteria (ss.7–9). It therefore changes the operative criteria used to link ingrown nail (and death from it) to relevant service for claims brought under s.120B of the VEA or s.339 of the MRCA (s.5), altering the scope of decision‑making compared with the repealed instrument."},"complexity_factors":["Medical definition and ICD-10-AM reference for ingrown nail requiring clinical interpretation (s.7(2)-(3)).","Multiple, discrete temporal proximity windows for different factors (e.g. 14 days, 7 days, 4 weeks, 6 months, 1 year) that must be assessed against clinical onset or worsening (s.9).","Range of causal factors spanning anatomical deformity, prior injury, drug exposures, footwear and infections—each with different evidentiary needs (s.9).","Distinction between clinical onset and clinical worsening, and a rule limiting clinical-worsening factors to pre-existing conditions (s.10(2)).","Requirement that any listed factor must be related to the person's relevant service (s.10(1)), introducing a legal link beyond medical causation.","Interaction with other Statements of Principles where factors reference other injuries/diseases (s.11), creating cross-document dependency.","Repeal of the prior Statement (No.107 of 2015) and replacement with new factors and definitions (s.4).","Application limited to specified claim types under the VEA and MRCA, requiring claimants to fit statutory claim categories (s.5)."],"plain_english_summary":"This instrument sets the medical rules the Repatriation Medical Authority will use to decide if an ingrown nail (or death contributed to by one) is connected to a veteran’s or service member’s service for claims under the VEA or MRCA. It defines ingrown nail, lists specific contributing factors and timeframes (for example injury, toe deformity, certain drugs, footwear, diabetes, fungal infection, or lack of timely treatment), and replaces the 2015 Statement; the RMA says this follows the available medical‑scientific evidence."},"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":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the same narrow scope as its 2015 predecessor. It addresses only ingrown nail claims under the veterans' compensation scheme, with no expansion into related conditions or broader policy areas. The update appears to be a routine republication with minor modernisation (updating ICD-10-AM references and medication lists) rather than a scope expansion."},"complexity_factors":["Short, single-purpose instrument (approximately 1,500 words)","Only 5 defined terms in the Dictionary (ingrown nail, MRCA, relevant service, terminal event, VEA)","Clear, numbered list of 9 factors in section 9 with minimal cross-referencing","Simple temporal requirements (specific time windows like '6 months before' or '14 days before')","Single conditional structure in section 11 (reference to other Statements of Principles)","No nested exceptions or complex definitional chains","Straightforward repeal and commencement provisions"],"plain_english_summary":"This Statement of Principles tells the DVA when ingrown toenails can be accepted as caused or aggravated by military service, applying to veterans and current/former defence members claiming under the VEA or MRCA. It replaces the 2015 version.\n\nIt matters because ingrown nails can lead to infection and disability; claimants must show on the balance of probabilities that service-related factors (for example foot deformity, recent injury or medications, prolonged tight boots, diabetes, infection, or inadequate care) probably caused or worsened the condition. Pre‑existing nails allow only claims for worsening."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-ingrown-nail-balance-of-probabilities-no-73-of-2024","history":"/api/acts/statement-of-principles-concerning-ingrown-nail-balance-of-probabilities-no-73-of-2024/history","analysis":"/api/acts/statement-of-principles-concerning-ingrown-nail-balance-of-probabilities-no-73-of-2024/analysis","conflicts":"/api/acts/statement-of-principles-concerning-ingrown-nail-balance-of-probabilities-no-73-of-2024/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-ingrown-nail-balance-of-probabilities-no-73-of-2024/important-cases","documents":"/api/acts/statement-of-principles-concerning-ingrown-nail-balance-of-probabilities-no-73-of-2024/documents"}}