{"id":"F2023L01434","name":"Statement of Principles concerning medial tibial stress syndrome (shin splints) (Balance of Probabilities) (No. 97 of 2023)","slug":"statement-of-principles-concerning-medial-tibial-stress-syndrome-shin-splints-balance-of-probabiliti","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442144,"registerId":"F2023L01434-fast-fetch-1775957231791","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning medial tibial stress syndrome (shin splints) (Balance of Probabilities) (No. 97 of 2023)","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\n\n \n\nStatement of Principles\n\nconcerning\n\nMEDIAL TIBIAL STRESS SYNDROME (SHIN SPLINTS) (Balance of Probabilities)\n\n(No. 97 of 2023)\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 25 October 2023.\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 Terence Campbell AM
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 medial tibial stress syndrome (shin splints) (Balance of Probabilities) (No. 97 of 2023).\n\n2 Commencement\n\n This instrument commences on 28 November 2023.\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 shin splints No. 10 of 2015 (Federal Register of Legislation No. F2014L01812) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 medial tibial stress syndrome (shin splints) and death from medial tibial stress syndrome (shin splints).\n\nMeaning of medial tibial stress syndrome (shin splints)\n\n(2) For the purposes of this Statement of Principles, medial tibial stress syndrome (shin splints):\n\n(a) means a bone stress reaction or periosteal inflammation manifesting as exercise-induced pain along the posteromedial aspect of the distal two-thirds of the tibia which typically resolves or reduces with rest; and\n\n(b) excludes:\n\n(i) fracture, including stress fracture;\n\n(ii) lower leg tendinopathies or bursitis;\n\n(iii) nerve entrapments (sural or superficial peroneal);\n\n(iv) popliteal artery entrapment syndrome;\n\n(v) acute sprain and acute strain; and \n\n(vi) vascular insufficiency.\n\nDeath from medial tibial stress syndrome (shin splints)\n\n(3) For the purposes of this Statement of Principles, medial tibial stress syndrome (shin splints), in relation to a person, includes death from a terminal event or condition that was contributed to by the person's medial tibial stress syndrome (shin splints).\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 medial tibial stress syndrome (shin splints) and death from medial tibial stress syndrome (shin splints) 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, medial tibial stress syndrome (shin splints) or death from medial tibial stress syndrome (shin splints) is connected with the circumstances of a person's relevant service:\n\n(1) running or jogging an average of at least 60 kilometres per week for the 4 weeks before the clinical onset or clinical worsening of medial tibial stress syndrome (shin splints);\n\n(2) undertaking weight bearing exercise involving repeated activity of the lower leg on the affected side for:\n\n(a) a minimum intensity of 5 METS; and\n\n(b) for at least 6 hours per week; and\n\nfor at least the 4 weeks before the clinical onset or clinical worsening of medial tibial stress syndrome (shin splints);\n\nNote 1: Examples of weight bearing exercise involving repeated activity of the lower leg at a minimum intensity of 5 METS include marching, sustained brisk walking, playing football, and dancing.\n\nNote 2: MET is defined in the Schedule 1 - Dictionary.\n\n(3) increasing the frequency, duration or intensity of weight bearing activity involving the lower leg on the affected side:\n\n(a) by at least 100 percent; and\n\n(b) to a minimum intensity of 5 METs; and\n\n(c) for at least 4 hours per day;\n\nwithin the 2 weeks before the clinical onset or clinical worsening of medial tibial stress syndrome (shin splints);\n\nNote: MET is defined in the Schedule 1 - Dictionary.\n\n(4) having pes planus of the affected limb before the clinical onset or clinical worsening of medial tibial stress syndrome (shin splints);\n\n(5) inability to obtain appropriate clinical management for medial tibial stress syndrome (shin splints) before the clinical worsening of medial tibial stress syndrome (shin splints).\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 clinical worsening aspects of factors set out in section 9 apply only to material contribution to, or aggravation of, medial tibial stress syndrome (shin splints) where the person's medial tibial stress syndrome (shin splints) 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\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n medial tibial stress syndrome (shin splints)—see subsection 7(2).\n\n MET means a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute, or 1.0 kcal/kg of body weight per hour, or resting metabolic rate.\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 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":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the same narrow scope as its 2015 predecessor. It remains tightly focused on establishing the causal connection between military service and medial tibial stress syndrome. The update appears to be a routine medical evidence refresh rather than an expansion of scope, replacing the 2015 version with updated scientific understanding but preserving the same fundamental purpose and structure."},"complexity_factors":["Short, focused instrument (approximately 1,500 words) dealing with a single medical condition","Only 5 defined terms in the Dictionary (MET, MRCA, relevant service, terminal event, VEA)","Clear, numbered list of 5 factors in section 9 with minimal cross-referencing","Simple conditional structure: 'at least one of the following factors must exist'","Some medical terminology requires explanation (METS, pes planus, posteromedial aspect) but these are either defined or explained in notes","Single exclusion list in section 7(2) clearly delineating what is NOT covered","No nested exceptions or complex temporal calculations beyond straightforward '4 weeks before' or '2 weeks before' timeframes"],"plain_english_summary":"This instrument updates the medical test for compensable medial tibial stress syndrome (shin splints) for veterans and serving/former defence members, replacing the 2015 guidance and aligning decisions with current evidence. \n\nIt narrows eligibility to shin‑splints (not fractures or tendon/circulatory problems) and ties compensation to specific service‑related triggers; failing to show a service connection on the balance of probabilities will likely mean denial."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2015 Statement of Principles (section 4) and replaces it with a new Statement that: (a) applies to claims under the VEA and MRCA (section 5); (b) sets specific quantitative activity thresholds and timing requirements (section 9); and (c) expressly includes death from a terminal event contributed to by the condition (section 7(3)). Precise differences from the repealed 2015 instrument cannot be determined from this text alone without a side‑by‑side comparison of the prior Statement."},"complexity_factors":["Quantitative exposure thresholds require factual proof and conversion (running ≥60 km/week; MET≥5; hours/day/week) (section 9(1)–(3); Schedule 1).","Technical medical definition and listed exclusions constrain diagnosis (what counts as medial tibial stress syndrome; excludes fracture, tendinopathy, nerve entrapment etc.) (section 7(2)).","Temporal linking of clinical onset or clinical worsening to service requires precise medical timing and documentary evidence (sections 9 and 10).","Clinical concepts (\"clinical onset\", \"clinical worsening\", \"terminal event\") require expert medical judgment (section 7(2)-(3); Schedule 1).","Interplay with other Statements of Principles may require cross-referencing and applying different instruments where overlap exists (section 11).","Application limited to claims under specific statutes (VEA s120B; MRCA s339) and replaces a prior statement (sections 5 and 4), affecting administrative processing.","Standard of proof is the balance of probabilities; evidentiary burden lies on claim assessment (title and section 8)."],"plain_english_summary":"This Statement of Principles sets the medical definition and the specific activity and clinical criteria used to decide, on the balance of probabilities, whether medial tibial stress syndrome (shin splints) is connected with a person’s military \"relevant service\" for claims under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act. It prescribes measurable thresholds (running kilometres, MET-based weight‑bearing activity, rapid increases, pes planus, and failure to obtain treatment) and also covers death where a terminal event was contributed to by the condition."},"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-medial-tibial-stress-syndrome-shin-splints-balance-of-probabiliti","history":"/api/acts/statement-of-principles-concerning-medial-tibial-stress-syndrome-shin-splints-balance-of-probabiliti/history","analysis":"/api/acts/statement-of-principles-concerning-medial-tibial-stress-syndrome-shin-splints-balance-of-probabiliti/analysis","conflicts":"/api/acts/statement-of-principles-concerning-medial-tibial-stress-syndrome-shin-splints-balance-of-probabiliti/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-medial-tibial-stress-syndrome-shin-splints-balance-of-probabiliti/important-cases","documents":"/api/acts/statement-of-principles-concerning-medial-tibial-stress-syndrome-shin-splints-balance-of-probabiliti/documents"}}