{"id":"F2023L01433","name":"Statement of Principles concerning medial tibial stress syndrome (shin splints) (Reasonable Hypothesis) (No. 96 of 2023)","slug":"statement-of-principles-concerning-medial-tibial-stress-syndrome-shin-splints-reasonable-hypothesis-","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442145,"registerId":"F2023L01433-fast-fetch-1775957231794","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) (Reasonable Hypothesis) (No. 96 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) (Reasonable Hypothesis)\n\n(No. 96 of 2023)\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 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) (Reasonable Hypothesis) (No. 96 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning shin splints No. 9 of 2015 (Federal Register of Legislation No. F2014L01805) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates 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, 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 medial tibial stress syndrome (shin splints) or death from medial tibial stress syndrome (shin splints) with the circumstances of a person's relevant service:\n\n(1) running or jogging an average of at least 30 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 4 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 2 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(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 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) 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":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier 2015 Statement of Principles (s4) and reissues a Statement that sets a specific diagnostic definition, activity/intensity thresholds and service‑linking rules (ss7–11). Those changes alter the substantive criteria adjudicators must apply when assessing whether medial tibial stress syndrome is related to relevant service (ss3–5,9)."},"complexity_factors":["Numeric exposure thresholds and temporal windows required to raise a reasonable hypothesis (s9(1)–(3))","Use of METs as an intensity measure and its technical definition in the Schedule (s9(2), Schedule)","Detailed clinical definition with multiple explicit exclusions (s7(2))","Rules on clinical worsening and temporal relationship to service (s10(1)–(2))","Cross-reference to other Statements of Principles when overlapping injuries/diseases occur (s11)","Inclusion of death via contribution from a terminal event and the Schedule’s definition of terminal event (s7(3), Schedule)","Repeal and replacement of the prior Statement (s4) requiring attention to changed wording and criteria"],"plain_english_summary":"This instrument defines medial tibial stress syndrome (shin splints), sets specific clinical exclusions, and lists the activity and clinical thresholds the Repatriation Medical Authority uses to form a 'reasonable hypothesis' that the condition is related to a person’s military service. It replaces the earlier 2015 statement and applies to claims under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004 (ss3–5,4). The Authority decides whether the listed activity thresholds (for example, running ≥30 km/week, MET-based weight‑bearing, pes planus, or lack of appropriate management) link the condition to relevant service (s9)."},"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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement of an existing Statement of Principles under the Veterans' Entitlements Act framework. It maintains the same scope as its 2015 predecessor—determining service connection for shin splints compensation claims. The update reflects current medical terminology and evidence standards without expanding beyond the original purpose of establishing eligibility criteria for this specific condition."},"complexity_factors":["Moderate cross-referencing between the VEA and MRCA compensation schemes","Technical medical definitions requiring precise measurement (METs, specific anatomical locations like 'posteromedial aspect of the distal two-thirds of the tibia')","Quantified thresholds for activity levels (30km/week, 4 hours/week, 5 METs, 100% increase, 2 weeks vs 4 weeks)","Nested conditions in factor (2) requiring simultaneous satisfaction of intensity, duration, and timeframe requirements","Six specific exclusions in the definition requiring differentiation from similar conditions","Dual application to both 'clinical onset' (new condition) and 'clinical worsening' (aggravation of pre-existing condition) with different rules in section 10(2)"],"plain_english_summary":"This instrument replaces the 2015 shin‑splints policy with updated medical evidence and sets out five specific service‑related scenarios (including sustained heavy running or weight‑bearing activity, sudden large increases in lower‑leg load, pre‑existing flat feet, or inability to obtain treatment) needed to accept medial tibial stress syndrome as caused by service. It excludes stress fractures, tendon, nerve injuries and acute sprains.\n\nIt applies to current and former ADF members claiming under the VEA or MRCA and uses the “reasonable hypothesis” causation standard."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-medial-tibial-stress-syndrome-shin-splints-reasonable-hypothesis-","history":"/api/acts/statement-of-principles-concerning-medial-tibial-stress-syndrome-shin-splints-reasonable-hypothesis-/history","analysis":"/api/acts/statement-of-principles-concerning-medial-tibial-stress-syndrome-shin-splints-reasonable-hypothesis-/analysis","conflicts":"/api/acts/statement-of-principles-concerning-medial-tibial-stress-syndrome-shin-splints-reasonable-hypothesis-/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-medial-tibial-stress-syndrome-shin-splints-reasonable-hypothesis-/important-cases","documents":"/api/acts/statement-of-principles-concerning-medial-tibial-stress-syndrome-shin-splints-reasonable-hypothesis-/documents"}}