{"id":"F2019L00645","name":"Statement of Principles concerning joint instability (Reasonable Hypothesis) (No. 57 of 2019)","slug":"statement-of-principles-concerning-joint-instability-reasonable-hypothesis-no-57-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440060,"registerId":"F2019L00645-fast-fetch-1775955839232","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning joint instability (Reasonable Hypothesis) (No. 57 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 (Reasonable Hypothesis)\n\n(No. 57 of 2019)\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 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 (Reasonable Hypothesis) (No. 57 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning joint instability No. 32 of 2010 (Federal Register of Legislation No. F2010L01048) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that joint instability and death from joint instability 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 joint instability or death from joint instability 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) being pregnant within the six weeks before the clinical onset of joint instability;\n\n(8) 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(9) 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(10) 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(11) for tibiofemoral joint instability only, being severely obese at the time of the clinical onset of joint instability;\n\nNote: being severely obese is defined in the Schedule 1 - Dictionary.\n\n(12) for total knee joint prosthesis joint instability only, having morbid obesity at the time of the clinical onset of joint instability;\n\n(13) for elbow joint instability only, having more than three local glucocorticoid injections for epicondylitis before the clinical onset of joint instability;\n\n(14) 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(15) 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(16) 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(17) 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(18) being pregnant within the six weeks before the clinical worsening of joint instability;\n\n(19) 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(20) 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(21) 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(22) for tibiofemoral joint instability only, being severely obese at the time of the clinical worsening of joint instability;\n\nNote: being severely obese is defined in the Schedule 1 - Dictionary.\n\n(23) for total knee joint prosthesis joint instability only, having morbid obesity at the time of the clinical worsening of joint instability;\n\n(24) for elbow joint instability only, having more than three local glucocorticoid injections for epicondylitis before the clinical worsening of joint instability;\n\n(25) 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(14) to 9(25) 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(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\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 being severely obese means having a Body Mass Index (BMI) of 35 or greater.\n\n Note: 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 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 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) 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 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","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument replaces the 2010 version (No. 32 of 2010) and maintains the same core purpose: establishing medical criteria for joint instability claims. The scope remains tightly focused on defining compensable connections between joint instability and military service. While the specific factors have been updated with contemporary medical understanding (including expanded coverage of prosthetic joints and obesity-related factors), the fundamental scope as a medical-determination instrument under the Veterans' Entitlements Act has not expanded beyond its original intent."},"complexity_factors":["25 distinct factors with multiple sub-categories and joint-specific carve-outs (factors 8-13 and 19-24 apply only to specific joint types)","Dual timeline structure: separate factors for 'clinical onset' (factors 1-13) versus 'clinical worsening' (factors 14-24), plus factor 25 applying to both","Cross-referencing to external medical classification system (ICD-10-AM Tenth Edition) with specific ISBN and effective date","Nested definitions requiring dictionary consultation: 'soft tissue structure as specified', 'disease process as specified', 'terminal event', 'relevant service', and BMI calculations","Conditional logic in section 10(2) restricting factors 14-25 to aggravation cases where condition pre-existed service","Incorporation by reference to other Statements of Principles for conditions mentioned in the factors (section 11)"],"plain_english_summary":"This instrument sets medical rules for when veterans and defence force members can claim compensation for joint instability—recurrent dislocations, subluxations or sprains, including some prosthetic joints—under the \"reasonable hypothesis\" test. It identifies 25 medical and causal factors that, if present, let a clinician reasonably link the condition to service.\n\nIt affects veterans, peacekeepers and current/former defence members claiming under the VEA or MRCA and matters because it lowers the evidentiary bar to establish service-related injury."},"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":5,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2010 Statement of Principles (section 4) and replaces it with updated criteria. The replacement adds and clarifies condition‑specific factors and definitions (for example pregnancy timing, graduated BMI thresholds, prosthesis inclusions/exclusions, temporomandibular and joint‑specific factors), clarifies ICD‑10‑AM code references (section 7(3)–(4)), and specifies application to claims under VEA and the MRCA (section 5)."},"complexity_factors":["Multiple, condition‑specific enumerated factors (sections 9(1)–9(25)) requiring factual and medical proof","Technical medical terminology and ICD‑10‑AM code references (section 7(3)–(4))","Interplay with other legislation and claim schemes (application to VEA s120A and MRCA s338 — section 5)","Cross‑references to other Statements of Principles (section 11) creating dependency and layered interpretation","Defined medical thresholds and categories (BMI thresholds in Schedule 1) that create measurable but discrete cutoffs","Service‑connection nuance: material contribution/aggravation versus arising out of service (section 10(2))","Specific inclusions/exclusions and joint‑specific clauses (eg prosthesis exclusions, temporomandibular and joint‑specific obesity rules)"],"plain_english_summary":"This instrument repeals the 2010 Statement and sets the medical criteria the Repatriation Medical Authority uses to decide whether joint instability (including death from it) can be reasonably hypothesised to be related to a person’s military service. It is applied when assessing claims under the Veterans' Entitlements Act or the Military Rehabilitation and Compensation Act. The Authority says its view is based on medical‑scientific evidence and lists specific clinical factors and definitions (eg trauma, prior dislocation or sprain, soft‑tissue or bony damage, disease processes, pregnancy, BMI thresholds, prostheses) that administrators must consider."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-joint-instability-reasonable-hypothesis-no-57-of-2019","history":"/api/acts/statement-of-principles-concerning-joint-instability-reasonable-hypothesis-no-57-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-joint-instability-reasonable-hypothesis-no-57-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-joint-instability-reasonable-hypothesis-no-57-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-joint-instability-reasonable-hypothesis-no-57-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-joint-instability-reasonable-hypothesis-no-57-of-2019/documents"}}