{"id":"F2024L01051","name":"Statement of Principles concerning ingrown nail (Reasonable Hypothesis) (No. 72 of 2024)","slug":"statement-of-principles-concerning-ingrown-nail-reasonable-hypothesis-no-72-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442543,"registerId":"F2024L01051-fast-fetch-1775957517949","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning ingrown nail (Reasonable Hypothesis) (No. 72 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  (Reasonable Hypothesis)\n\n(No. 72 of 2024)\n\n \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 \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 \n\n \n\nContents\n\n \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 (Reasonable Hypothesis) (No. 72 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(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning ingrowing nail No. 106 of 2015 (Federal Register of Legislation No. F2015L01326) made under subsection 196B(2) of the VEA is repealed.\n\n1.                Application\n\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\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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that ingrown nail and death from ingrown nail 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\n1.                Factors that must exist\n\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 ingrown nail or death from ingrown nail 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 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\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;\n3.           having hyperhidrosis affecting the feet within the 7 days before the clinical onset or clinical worsening;\n4.           having  an inability to regularly wash feet or socks within the 7 days before clinical worsening;\n5.           having diabetes mellitus at the time of clinical onset or clinical worsening;\n6.           having a fungal infection involving the affected nail within the 1 year before clinical onset or clinical worsening;\n7.       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(2) 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)          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":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This is a straightforward reissue/replacement of the 2015 Statement of Principles concerning ingrowing nail. The scope remains limited to determining liability for ingrown nail conditions in veterans' compensation claims. The 2024 version appears to update references (ICD-10-AM Tenth Edition) and possibly refine factors, but does not expand beyond the original purpose of establishing service connection criteria for this specific dermatological condition."},"complexity_factors":["Short, focused instrument (approximately 1,500 words) dealing with a single medical condition","Only 5 defined terms in the Dictionary (ingrown nail, MRCA, relevant service, terminal event, VEA)","Clear, numbered list of 11 factors in section 9 with minimal cross-referencing","Simple conditional structure: 'at least one factor must exist' rather than complex nested logic","Straightforward application provisions referencing only two primary Acts (VEA and MRCA)","Single layer of exceptions (clinical worsening provisions in section 10) without sub-exceptions","Standard template structure common to all Repatriation Medical Authority Statements of Principles"],"plain_english_summary":"This instrument sets when Australian veterans and current or former defence personnel can claim compensation for ingrown nails under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act. Claims require a “reasonable hypothesis” linking the condition to operational, peacekeeping, hazardous or warlike service (or service-related worsening of a pre‑existing problem), including complications causing death. It recognizes service factors like footwear, field hygiene and service‑related injury while guarding against unrelated claims."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the prior Statement of Principles (No. 106 of 2015) (see section 4) and substitutes a current set of factors (see section 9) and definitions (see section 7 and Schedule 1). From the text alone it is clear that the new instrument updates and clarifies specific listed factors, time windows and the definition of ingrown nail (including retronychia), but the precise extent and direction of change relative to the 2015 text cannot be determined from this instrument alone because the earlier instrument’s wording is not reproduced."},"complexity_factors":["Use of the legal test 'reasonable hypothesis' to link condition to service, requiring interpretation of evidential thresholds (see section 9 introductory text).","Precise medical definition of ingrown nail (includes retronychia) and death-by-terminal-event linkage, requiring clinicians to map clinical records to legal definitions (see section 7(2) and 'Death from ingrown nail').","Multiple, differing temporal windows for different factors (e.g. 6 months for injury or listed medications; 14 days for nail trimming; 4 weeks with ≥8 hours/day for footwear; 7 days for hyperhidrosis or hygiene; 1 year for fungal infection) that increase evidential complexity (see section 9).","Distinction between clinical onset and clinical worsening and the limited application of 'worsening' (applies only where condition pre‑existed service), which affects causation analysis (see section 10.1.2).","Cross‑references to other Statements of Principles where overlapping injuries/diseases exist, requiring review of other SOPs and application rules (see section 11).","Dependence on statutory claim frameworks (applies only to claims under specified sections of the VEA and the MRCA), producing legal‑administrative coupling rather than standalone medical rules (see section 5).","Administrative transition risk from repeal of the earlier 2015 Statement (requires mapping prior decisions to the new instrument) (see section 4).","Inclusion of both clinical and non‑clinical factors (e.g. inability to obtain appropriate care, footwear characteristics, trimming behaviour) which broadens the kinds of evidence decision‑makers must assess (see section 9.4–9.7 and 9.11)."],"plain_english_summary":"This Statement of Principles sets the medical criteria the Repatriation Medical Authority uses to decide whether an ingrown nail (including retronychia) or death from it can be connected to a person’s relevant service for claims under the VEA and the MRCA.  \n\nIt lists specific, time‑bounded factors—injury or digit deformity, certain medications, footwear pressure, diabetes, fungal infection, hygiene problems and failure to obtain care—that, if present, raise a reasonable hypothesis and so shape the medical evidence veterans and clinicians must provide."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-ingrown-nail-reasonable-hypothesis-no-72-of-2024","history":"/api/acts/statement-of-principles-concerning-ingrown-nail-reasonable-hypothesis-no-72-of-2024/history","analysis":"/api/acts/statement-of-principles-concerning-ingrown-nail-reasonable-hypothesis-no-72-of-2024/analysis","conflicts":"/api/acts/statement-of-principles-concerning-ingrown-nail-reasonable-hypothesis-no-72-of-2024/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-ingrown-nail-reasonable-hypothesis-no-72-of-2024/important-cases","documents":"/api/acts/statement-of-principles-concerning-ingrown-nail-reasonable-hypothesis-no-72-of-2024/documents"}}