{"id":"F2019L00644","name":"Statement of Principles concerning joint instability (Balance of Probabilities) (No. 58 of 2019)","slug":"statement-of-principles-concerning-joint-instability-balance-of-probabilities-no-58-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440057,"registerId":"F2019L00644-fast-fetch-1775955837123","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning joint instability (Balance of Probabilities) (No. 58 of 2019)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nJOINT INSTABILITY (Balance of Probabilities)\n\n(No. 58 of 2019)\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 26 April 2019\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 Nicholas Saunders AO
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 joint instability (Balance of Probabilities) (No. 58 of 2019).\n\n2 Commencement\n\n This instrument commences on 27 May 2019.\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 joint instability No. 33 of 2010 (Federal Register of Legislation No. F2010L01049) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 joint instability and death from joint instability.\n\nMeaning of joint instability\n\n(2) For the purposes of this Statement of Principles, joint instability:\n\n(a) means an acquired lack of stability of a joint due to damage to or abnormality of the stabilising structures of that joint, manifesting as recurrent subluxation, recurrent dislocation or recurrent sprain; and\n\n(b) includes joints with an internal joint prosthesis; and\n\n(c) excludes spondylolisthesis, and the loosening or migration of the fixation component of an internal joint prosthesis.\n\n(3) While joint instability attracts ICD‑10‑AM code M22.0, M22.1, M23.5, M24.2, M24.4, M25.3, M43.3, M43.4, M43.5, M53.2 or T84.0, in applying this Statement of Principles the meaning of joint instability 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 joint instability\n\n(5) For the purposes of this Statement of Principles, joint instability, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's joint instability.\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 joint instability and death from joint instability 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, joint instability or death from joint instability is connected with the circumstances of a person's relevant service:\n\n(1) having physical trauma to the affected joint at the time of the clinical onset of joint instability;\n\nNote: Examples of activities and circumstances involving trauma to the affected joint include, but are not limited to, falls, collisions, lifting weights, push ups, pull ups, throwing objects, seizure and electrical injury. \n\n(2) having a dislocation or subluxation of the affected joint before the clinical onset of joint instability;\n\n(3) having a sprain of the affected joint before the clinical onset of joint instability;\n\n(4) having damage to a soft tissue structure as specified before the clinical onset of joint instability;\n\nNote: soft tissue structure as specified is defined in the Schedule 1 – Dictionary.\n\n(5) having a fracture or bony abnormality involving the articulating surfaces of the affected joint before the clinical onset of joint instability;\n\nNote: Examples of conditions which can cause a bony abnormality include, but are not limited to, osteonecrosis, dysbaric osteonecrosis and femoroacetabular impingement.\n\n(6) having a disease process as specified affecting the normal structural or functional relationship between the articulating surfaces of the affected joint at the time of the clinical onset of joint instability;\n\nNote: disease process as specified is defined in the Schedule 1 - Dictionary. \n\n(7) for temporomandibular joint instability only, undertaking an activity or undergoing a medical procedure that involves wide opening of the mouth at the time of the clinical onset of joint instability;\n\nNote 1: Examples of activities which may involve wide mouth opening include, but are not limited to, yawning, laughing, vomiting, coughing, and chewing large pieces of food.\n\nNote 2: Examples of medical procedures that involve wide mouth opening include, but are not limited to, dental procedures, direct laryngoscopy, and intravenous administration of medications which cause drug-induced yawning.\n\n(8) for total hip prosthesis joint instability only, having lumbar spondylosis, lumbar intervertebral disc prolapse, lumbar spondylolisthesis, lumbar spinal stenosis or lumbar spinal fusion at the time of the clinical onset of joint instability;\n\n(9) for total hip joint prosthesis joint instability only, being obese at the time of the clinical onset of joint instability;\n\nNote: being obese is defined in the Schedule 1 - Dictionary. \n\n(10) for tibiofemoral joint instability only, having morbid obesity at the time of the clinical onset of joint instability;\n\n(11) having physical trauma to the affected joint at the time of the clinical worsening of joint instability;\n\nNote: Examples of activities and circumstances involving trauma to the affected joint include, but are not limited to, falls, collisions, lifting weights, push ups, pull ups, throwing objects, seizure and electrical injury. \n\n(12) having damage to a soft tissue structure as specified before the clinical worsening of joint instability;\n\nNote: soft tissue structure as specified is defined in the Schedule 1 – Dictionary.\n\n(13) having a fracture or bony abnormality involving the articulating surfaces of the affected joint before the clinical worsening of joint instability;\n\nNote: Examples of conditions which can cause a bony abnormality include, but are not limited to, osteonecrosis, dysbaric osteonecrosis and femoroacetabular impingement.\n\n(14) having a disease process as specified affecting the normal structural or functional relationship between the articulating surfaces of the affected joint at the time of the clinical worsening of joint instability;\n\nNote: disease process as specified is defined in the Schedule 1 - Dictionary. \n\n(15) for temporomandibular joint instability only, undertaking an activity or undergoing a medical procedure that involves wide opening of the mouth at the time of the clinical worsening of joint instability;\n\nNote 1: Examples of activities which may involve wide mouth opening include, but are not limited to, yawning, laughing, vomiting, coughing, and chewing large pieces of food.\n\nNote 2: Examples of medical procedures that involve wide mouth opening include, but are not limited to, dental procedures, direct laryngoscopy, and intravenous administration of medications which cause drug-induced yawning.\n\n(16) for total hip prosthesis joint instability only, having lumbar spondylosis, lumbar intervertebral disc prolapse, lumbar spondylolisthesis, lumbar spinal stenosis or lumbar spinal fusion at the time of the clinical worsening of joint instability;\n\n(17) for total hip joint prosthesis joint instability only, being obese at the time of the clinical worsening of joint instability;\n\nNote: being obese is defined in the Schedule 1 - Dictionary. \n\n(18) for tibiofemoral joint instability only, having morbid obesity at the time of the clinical worsening of joint instability;\n\n(19) inability to obtain appropriate clinical management for joint instability.\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 factors set out in subsections 9(11) to 9(19) apply only to material contribution to, or aggravation of, joint instability where the person's joint instability 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\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 also defined in the Schedule 1 - Dictionary.\n\n BMI means W/H2 where:\n\nW is the person's weight in kilograms; and\n\nH is the person's height in metres.\n\n disease process as specified means:\n\n(a) a neurological, neuromuscular or muscular condition, including, but not limited to, brain or spinal injuries with spasticity or flaccid paralysis, cerebrovascular accident, Parkinson's disease, myasthenia gravis, poliomyelitis, dyskinesia caused by neuroleptic drugs, and peripheral neuropathy; or\n\n(b) an infective, inflammatory or degenerative condition of the affected joint, including, but not limited to, septic arthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthropathy, crystal arthropathy, Grisel syndrome and osteoarthritis; or\n\n(c) an intra-articular space occupying lesion, including, but not limited to, neoplastic lesions such as sarcoma, osteosarcoma, chondrosarcoma and pigmented villonodular synovitis.\n\nNote: Grisel syndrome is atlantoaxial joint subluxation due to contiguous inflammation from the ear, nose or throat.\n\n joint instability—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 soft tissue structure as specified means a joint capsule, tendon, ligament or fibrocartilaginous structure that contributes to joint stability in the affected joint.\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\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":5,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles that updates the 2010 version (No. 33 of 2010). It maintains the same core purpose: establishing medical causation factors for joint instability claims. The scope remains tightly focused on defining the condition and listing service-connection factors for veterans' compensation purposes. The structure and approach are consistent with other Repatriation Medical Authority instruments."},"complexity_factors":["19 distinct factors with specific temporal requirements ('at the time of clinical onset' vs 'before clinical onset' vs 'at the time of clinical worsening')","Joint-specific carve-outs: 3 factors apply only to temporomandibular joints, 2 apply only to total hip prostheses, and 1 applies only to tibiofemoral joints","Cross-referencing to other Statements of Principles (section 11) for conditions mentioned in the factors","Nested definitions: 'disease process as specified' contains 3 sub-categories with 'including but not limited to' lists, and 'soft tissue structure as specified' requires anatomical knowledge","Mathematical formula for BMI with specific threshold values (30 for obesity, implied higher threshold for 'morbid obesity' though not explicitly defined)","Dual legislative framework application (VEA and MRCA with different service definitions)","Specific exclusion of spondylolisthesis and prosthesis component loosening from the definition","ICD-10-AM code referencing with specific edition and ISBN citation"],"plain_english_summary":"This Statement of Principles by the Repatriation Medical Authority (under the Veterans' Entitlements Act 1986) sets the medical rules for deciding when veterans and current/former defence members can get compensation for joint instability. It defines the condition, covers prosthetic joints (with exclusions), and lists 19 service‑related factors used to prove causation or worsening on the balance of probabilities.\n\nWhy it matters: it determines whether unstable joints from service‑related injury, wear or treatment qualify for compensation and medical support under the VEA or MRCA."},"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"},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This 2019 instrument replaces the 2010 Statement of Principles for joint instability (s.4) and expands/clarifies scope in several concrete ways: it expressly includes joints with internal prostheses while excluding prosthesis fixation loosening/migration (s.7(2)(b)-(c)); it expressly includes death from terminal events contributed to by joint instability (s.7(5)); it sets explicit obesity and morbid obesity thresholds affecting prosthesis and tibiofemoral instability (s.9(9),(10),(17),(18); Schedule 1); it adds an inability to obtain appropriate clinical management as a potential factor (s.9(19)); and it sets out more joint‑specific triggers (temporomandibular wide‑mouth activities, and lumbar spine conditions for total hip prosthesis) (s.9(7),(8),(15),(16)). Overall, the instrument retains the original purpose (linking joint instability to relevant service) but broadens and fine‑tunes the medical and circumstantial pathways by which service connection may be established."},"complexity_factors":["Section 9 lists 19 distinct factors (9(1)–9(19)), with multiple joint‑specific variants and separate rules for clinical onset vs clinical worsening","Schedule 1 contains multiple defined terms that affect interpretation (e.g. joint instability, disease process as specified, soft tissue structure, being obese, BMI, terminal event, relevant service, MRCA, VEA)","Conditional application: subsections 9(11)–9(19) are limited by s.10(2) to material contribution/aggravation where instability pre‑existed service","Cross‑references to other SOPs (s.11) create dependence on external instruments and their updates","Reference to ICD‑10‑AM codes (s.7(3)) and a specific edition means external classification changes can affect interpretation","Several exclusions and inclusions narrow meaning (e.g. inclusion of joints with internal prosthesis but exclusion of prosthesis loosening/migration in s.7(2)(b)-(c))","Different standards for onset versus worsening and for different joints (temporomandibular, total hip prosthesis, tibiofemoral) increase branching logic"],"plain_english_summary":"**What this instrument does (mechanically)\n\n- Sets a Statement of Principles (SOP) that explains when \"joint instability\" and death from joint instability can be accepted as connected with a person's military \"relevant service\" for the purposes of claims under the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA) (see s.3 and s.5).\n- Repeals the earlier 2010 SOP on joint instability and replaces it with the 2019 version (s.4).\n- Defines \"joint instability\" and other key terms (Schedule 1) and lists the specific medical and circumstantial factors that, if present, mean it is more likely than not (balance of probabilities) that the joint instability is connected with service (ss.7–9).\n- Explains how factors must be related to service (s.10) and how this SOP interacts with other SOPs where a factor refers to another injury or disease (s.11).\n\nWho is affected\n\n- Veterans and current/former members of the Australian Defence Force who make claims under the VEA or MRCA for joint instability or death from joint instability (s.5).\n- Decision-makers in the Department of Veterans' Affairs (DVA) and tribunals who decide those claims, because the SOP is used as medical‑scientific guidance when assessing causal connection (s.8).\n- Medical practitioners and forensic experts who provide the clinical evidence relied on in claims.\n\nKey legal/medical definitions that matter in practice\n\n- \"Joint instability\": an acquired loss of joint stability due to damage or abnormality of the stabilising structures of the joint, showing as recurrent subluxation, dislocation or sprain; includes joints with internal prostheses but expressly excludes spondylolisthesis and loosening or migration of a prosthesis fixation component (s.7(2)).\n- \"Death from joint instability\": includes deaths where a terminal event or condition was contributed to by the person's joint instability (s.7(5) and Schedule definition of \"terminal event\").\n- \"Being obese\": BMI ≥ 30; BMI is defined as weight divided by height squared (Schedule 1).\n\nWhich facts will commonly establish service connection under this SOP\n\n- At least one of the factors in section 9 must be present for a causal link on the balance of probabilities. These include: contemporaneous physical trauma to the affected joint, prior dislocation/subluxation, prior sprain, soft‑tissue damage, fractures or bony abnormality, specified disease processes, and certain joint‑specific triggers (e.g. wide mouth opening for temporomandibular joint) (s.9).\n- Some factors are joint‑specific (e.g. obesity or lumbar spine conditions for hip prosthesis instability; morbid obesity for tibiofemoral instability) and some apply to either clinical onset or clinical worsening of instability (s.9(1)–9(19)).\n- If a listed factor refers to an injury/disease covered by another SOP, the terms of that other SOP apply (s.11).\n\nWhat the RMA claims as its basis and what that implies\n\n- The Repatriation Medical Authority (RMA) states there is sufficient medical‑scientific evidence to take the view that joint instability (and death from it) can be related to relevant service on the balance of probabilities (s.8). That is the evidentiary foundation for the SOP, but decision-makers still apply the SOP to the facts of each claim.\n\nPractical consequences, incentives and trade‑offs\n\n- Who pays: benefits awarded as a result of an accepted claim are ultimately paid by government (DVA), so a broader or clearer SOP can increase DVA liability for medical care, prostheses, pensions or other entitlements (s.5, s.8). The SOP itself does not create payment rules but supplies the causal test used in claims decisions.\n- Who decides: the RMA sets the SOP (s.3); DVA/tribunals apply it when deciding individual claims. The SOP narrows judicial/administrative discretion by listing factors that establish connection, but it does not remove the need to prove timing and relation to \"relevant service\" (s.10).\n- Evidence and compliance burden: claimants must produce clinical evidence demonstrating the presence and timing of one or more listed factors (e.g. medical records of trauma, imaging showing soft tissue or bony damage, BMI measurements, records of prosthesis). This shifts administrative work to claimants, medical practitioners and DVA case officers.\n- Implementation and administrative risk: the SOP cross‑references ICD‑10‑AM codes (s.7(3)) and other SOPs (s.11), so decision consistency depends on keeping multiple instruments and medical coding up to date. The BMI cut‑off and definitions are simple to apply but vulnerable to measurement/recording variation.\n- Effects on private actors: private clinicians provide the diagnostic and historical evidence; prosthesis manufacturers and private healthcare providers may see indirect effects through service‑related repair/revision work when claims are accepted. The SOP imposes little direct regulation on private firms.\n- Concentrated benefits and diffuse costs: benefits concentrate on claimants who can show the listed factors (including those with prosthetic joints or obesity‑related risks). Costs (increased DVA outlays) are spread across the public budget.\n\nCosts, opportunity costs and unintended consequences to watch for\n\n- Increased claim acceptances where the listed factors are present may raise DVA expenditures (s.9, Schedule definitions). Recording and verifying BMI, prior injuries and timing of clinical onset/worsening can be administratively costly.\n- There is some potential for substitution effects: claimants with pre‑existing instability may seek acceptance on the basis of \"material contribution or aggravation\" rules in s.10(2) rather than new injury, shifting liability onto the DVA.\n\nBottom line\n\n- The 2019 SOP is an updated, prescriptive medical‑evidentiary guide setting out the specific factors that, if shown, mean joint instability (or death from it) can be connected to relevant military service on the balance of probabilities. It standardises how medical and circumstantial facts are treated in claims, narrows the factual issues decision‑makers look for, and creates predictable evidentiary expectations for claimants and clinicians (see ss.7–11, Schedule 1)."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-joint-instability-balance-of-probabilities-no-58-of-2019","history":"/api/acts/statement-of-principles-concerning-joint-instability-balance-of-probabilities-no-58-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-joint-instability-balance-of-probabilities-no-58-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-joint-instability-balance-of-probabilities-no-58-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-joint-instability-balance-of-probabilities-no-58-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-joint-instability-balance-of-probabilities-no-58-of-2019/documents"}}