{"id":"F2018L00882","name":"Statement of Principles concerning knee bursitis (Balance of Probabilities) (No. 66 of 2018)","slug":"statement-of-principles-concerning-knee-bursitis-balance-of-probabilities-no-66-of-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439671,"registerId":"F2018L00882-fast-fetch-1775955608305","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning knee bursitis (Balance of Probabilities) (No. 66 of 2018)","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\nKNEE BURSITIS (Balance of Probabilities)\n\n(No. 66 of 2018)\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 June 2018\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:
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Professor Nicholas Saunders AO
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Application\n\n5 Definitions\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n7 Basis for determining the factors\n\n8 Factors that must exist\n\n9 Relationship to service\n\n10 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 knee bursitis (Balance of Probabilities) (No. 66 of 2018).\n\n2 Commencement\n\n This instrument commences on 23 July 2018.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 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\n5 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about knee bursitis and death from knee bursitis.\n\nMeaning of knee bursitis\n\n(2) For the purposes of this Statement of Principles, knee bursitis:\n\n(a) means inflammation or infection of a bursa around the knee joint; and\n\n(b) excludes popliteal (Baker) cyst.\n\nNote: Knee bursitis is characterised by pain, tenderness, redness, swelling and thickening in the region of the knee.\n\n(3) While knee bursitis attracts ICD‑10‑AM code M70.4 or M70.5, in applying this Statement of Principles the meaning of knee bursitis 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 knee bursitis\n\n(5) For the purposes of this Statement of Principles, knee bursitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's knee bursitis.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n7 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 knee bursitis and death from knee bursitis 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\n8 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, knee bursitis or death from knee bursitis is connected with the circumstances of a person's relevant service:\n\n(1) for knee bursitis other than prepatellar and superficial infrapatellar bursitis, running or jogging an average of at least 60 kilometres per week for the four weeks before the clinical onset of knee bursitis;\n\n(2) for prepatellar bursitis or superficial infrapatellar bursitis only, working whilst kneeling, crawling or pressing the anterior knee against a hard vertical surface for a cumulative period of at least 60 hours within the two months before the clinical onset of knee bursitis;\n\nNote: Examples of pressing the anterior knee against a hard vertical surface include working whilst standing against a guard rail on a rolling and pitching ship.\n\n(3) for medial collateral ligament bursitis only, pressing the medial side of the knee against a hard surface for a cumulative period of at least 60 hours within the two months before the clinical onset of knee bursitis;\n\nNote: Examples of pressing the medial knee against a hard surface include horseback riding or motorcycle riding.\n\n(4) having trauma to the affected knee bursa in the 30 days before the clinical onset of knee bursitis;\n\nNote: Examples of trauma include cuts, abrasions and lacerations of the affected knee bursa, repeated knocking or hitting the affected knee bursa, needle aspiration of the affected knee bursa and wearing a below knee amputation prosthesis.\n\n(5) having surgery to the knee of the affected side in the 30 days before the clinical onset of knee bursitis;\n\n(6) having a bacterial, fungal or algal infection of the affected knee bursa at the time of the clinical onset of knee bursitis;\n\n(7) for septic knee bursitis only, being in an immunocompromised state as specified at the time of the clinical onset of knee bursitis;\n\nNote: immunocompromised state as specified is defined in the Schedule 1 - Dictionary. \n\n(8) for prepatellar, superficial infrapatellar or pretibial bursitis only, having psoriasis, atopic dermatitis or other inflammatory skin disorder, where the skin disorder involves the skin of the extensor surface of the affected knee, at the time of the clinical onset of knee bursitis;\n\n(9) having a disease from the specified list of diseases at the time of the clinical onset of knee bursitis;\n\nNote: specified list of diseases is defined in the Schedule 1 - Dictionary.\n\n(10) for knee bursitis other than prepatellar and superficial infrapatellar bursitis, running or jogging an average of at least 60 kilometres per week for the four weeks before the clinical worsening of knee bursitis;\n\n(11) for prepatellar bursitis or superficial infrapatellar bursitis only, working whilst kneeling, crawling or pressing the anterior knee against a hard vertical surface for a cumulative period of at least 60 hours within the two months before the clinical worsening of knee bursitis;\n\nNote: Examples of pressing the anterior knee against a hard vertical surface include working whilst standing against a guard rail on a rolling and pitching ship.\n\n(12) for medial collateral ligament bursitis only, pressing the medial side of the knee against a hard surface for a cumulative period of at least 60 hours within the two months before the clinical worsening of knee bursitis;\n\nNote: Examples of pressing the medial knee against a hard surface include horseback riding or motorcycle riding.\n\n(13) having trauma to the affected knee bursa in the 30 days before the clinical worsening of knee bursitis;\n\nNote: Examples of trauma include cuts, abrasions and lacerations of the affected knee bursa, repeated knocking or hitting the affected knee bursa, needle aspiration of the affected knee bursa and wearing a below knee amputation prosthesis.\n\n(14) having surgery to the knee of the affected side in the 30 days before the clinical worsening of knee bursitis;\n\n(15) having a bacterial, fungal or algal infection of the affected knee bursa at the time of the clinical worsening of knee bursitis;\n\n(16) for septic knee bursitis only, being in an immunocompromised state as specified at the time of the clinical worsening of knee bursitis;\n\nNote: immunocompromised state as specified is defined in the Schedule 1 - Dictionary. \n\n(17) for prepatellar, superficial infrapatellar or pretibial bursitis only, having psoriasis, atopic dermatitis or other inflammatory skin disorder, where the skin disorder involves the skin of the extensor surface of the affected knee, at the time of the clinical worsening of knee bursitis;\n\n(18) having a disease from the specified list of diseases at the time of the clinical worsening of knee bursitis;\n\nNote: specified list of diseases is defined in the Schedule 1 - Dictionary.\n\n(19) inability to obtain appropriate clinical management for knee bursitis.\n\n9 Relationship to service\n\n(1) The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.\n\n(2) The factors set out in subsections 8(10) to 8(19) apply only to material contribution to, or aggravation of, knee bursitis where the person's knee bursitis was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n10 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 8 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 5\n\n1 Definitions\n\nIn this instrument:\n\n chronic renal failure means:\n\n(a) having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least three months; or\n\n(b) a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or\n\n(c) undergoing chronic dialysis.\n\n crystal-induced arthropathy means arthropathy resulting from the deposition of monosodium urate, calcium pyrophosphate dehydrate, calcium hydroxyapatite or calcium oxalate.\n\n immunocompromised state as specified means a condition of substantially lowered immune function, such as would occur in the following conditions or circumstances:\n\n(a) being infected with human immunodeficiency virus;\n\n(b) being treated with an immunosuppressive drug;\n\n(c) having a haematological or solid organ malignancy;\n\n(d) having chronic renal failure;\n\n(e) having severe malnutrition; or\n\n(f) undergoing solid organ, stem cell or bone marrow transplantation.\n\nNote: chronic renal failure and immunosuppressive drug are also defined in the Schedule 1 - Dictionary.\n\n immunosuppressive drug means a drug or an agent which results in substantial suppression of immune responses.\n\nNote: Examples of an immunosuppressive drug include corticosteroids other than inhaled or topical corticosteroids, drugs used to prevent transplant rejection, tumor necrosis factor- inhibitors and chemotherapeutic agents used for the treatment of cancer.\n\n knee bursitis—see subsection 6(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 specified list of diseases means:\n\n(a) ankylosing spondylitis;\n\n(b) enteropathic spondyloarthropathy;\n\n(c) gout, pseudogout, or other crystal-induced arthropathy;\n\n(d) pigmented villonodular proliferation;\n\n(e) polymyalgia rheumatica;\n\n(f) psoriatic arthropathy;\n\n(g) reactive arthritis;\n\n(h) rheumatoid arthritis;\n\n(i) sarcoidosis; or\n\n(j) undifferentiated spondyloarthropathy.\n\nNote: crystal-induced arthropathy is 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":{"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"This is a standard Repatriation Medical Authority Statement of Principles, which by design are narrow, condition-specific instruments. The scope remains tightly focused on establishing causal connections between knee bursitis and military service. There is no evidence of scope creep; the document follows the established template for such instruments with precise medical subcategorisation appropriate to the condition."},"complexity_factors":["19 distinct factors with specific temporal requirements (30 days, 4 weeks, 2 months) that vary by bursitis subtype","Subtype-specific application: factors (1)-(9) for onset vs (10)-(19) for worsening, with further restrictions (e.g., 'for prepatellar bursitis only', 'for septic knee bursitis only')","8 defined terms in Schedule 1, including nested definitions (e.g., 'immunocompromised state as specified' references 'chronic renal failure' and 'immunosuppressive drug', which are separately defined)","Cross-referencing mechanism in section 10 allowing incorporation of other Statements of Principles by reference","Dual statutory framework application (VEA and MRCA) with different service categories defined","Medical coding reference (ICD-10-AM Tenth Edition) with specific ISBN and effective date","Conditional logic in section 9(2) restricting worsening factors to pre-existing conditions not arising from service"],"plain_english_summary":"This instrument sets the legal test for linking knee bursitis to Australian military service under the Veterans' Entitlements Act 1986 and MRCA, using the balance‑of‑probabilities standard. It applies to veterans and current/former ADF members and lists specific service‑related and medical factors (e.g., intense running, prolonged kneeling, recent knee trauma or surgery, infection, certain pre‑existing immune/arthritic conditions) that can establish causation, while excluding Baker’s cysts. Its determinations determine entitlement to taxpayer-funded compensation."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":false,"description":"The instrument itself defines its scope: it applies to claims under section 120B of the VEA or section 339 of the MRCA and to knee bursitis (including death contributed to by it) as defined in subsection 6(2), while excluding popliteal (Baker) cyst. No text within the instrument indicates a change from a prior scope; it establishes the medical criteria and limits that govern connection-to-service assessments for affected claimants."},"complexity_factors":["Multiple subtype-specific criteria (prepatellar, superficial infrapatellar, medial collateral ligament, septic, pretibial) requiring different evidence paths","Several distinct temporal windows and quantitative thresholds (e.g. 60 km/week for four weeks; 60 cumulative hours within two months; 30-day trauma/surgery windows)","Dual application to clinical onset and to clinical worsening with different operative rules (sections 8(1)-(9) vs 8(10)-(19))","Cross-references to external statutes (VEA and MRCA) and to other Statements of Principles for overlapping injuries/diseases (section 10)","Technical medical definitions and exceptions in the Schedule (immunocompromised states, specified list of diseases, chronic renal failure, ICD-10-AM codes but overridden by the instrument’s definition)","Inclusion of inability to obtain appropriate clinical management as a factor (introducing evidentiary and administrative judgment)","Requirement that any listed factor be related to the person’s relevant service (creates a causation link to be established by facts of service)","Explicit exclusion (popliteal/Baker cyst) and limited coding guidance which may require clinical interpretation"],"plain_english_summary":"This instrument is a medical-legal rule that sets the conditions under which knee bursitis (and death contributed to by it) can be treated as connected with a veteran’s or member’s relevant service for claims under the VEA or MRCA. It defines knee bursitis, excludes Baker’s cyst, and identifies specific medical states, activities and time windows that must be present. The Repatriation Medical Authority’s findings are the medical basis decision-makers use to determine entitlement."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-knee-bursitis-balance-of-probabilities-no-66-of-2018","history":"/api/acts/statement-of-principles-concerning-knee-bursitis-balance-of-probabilities-no-66-of-2018/history","analysis":"/api/acts/statement-of-principles-concerning-knee-bursitis-balance-of-probabilities-no-66-of-2018/analysis","conflicts":"/api/acts/statement-of-principles-concerning-knee-bursitis-balance-of-probabilities-no-66-of-2018/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-knee-bursitis-balance-of-probabilities-no-66-of-2018/important-cases","documents":"/api/acts/statement-of-principles-concerning-knee-bursitis-balance-of-probabilities-no-66-of-2018/documents"}}