{"id":"F2019L01100","name":"Statement of Principles concerning Morton metatarsalgia (Balance of Probabilities) (No. 78 of 2019)","slug":"statement-of-principles-concerning-morton-metatarsalgia-balance-of-probabilities-no-78-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440206,"registerId":"F2019L01100-fast-fetch-1775955924019","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning Morton metatarsalgia (Balance of Probabilities) (No. 78 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\nMORTON METATARSALGIA (Balance of Probabilities)\n\n(No. 78 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 23 August 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 Morton metatarsalgia (Balance of Probabilities) (No. 78 of 2019).\n\n2 Commencement\n\n This instrument commences on 23 September 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 Morton's metatarsalgia No. 93 of 2010 (Federal Register of Legislation No. F2010L02849) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 Morton metatarsalgia and death from Morton metatarsalgia.\n\nMeaning of Morton metatarsalgia\n\n(2) For the purposes of this Statement of Principles, Morton metatarsalgia:\n\n(a) means an entrapment or irritation of the interdigital plantar nerve between the metatarsal heads, causing an acquired neuropathy; and\n\n(b) excludes peripheral neuropathy.\n\nNote 1: Morton metatarsalgia is also known as Morton neuroma.\n\nNote 2: Signs and symptoms of Morton metatarsalgia may include, but are not limited to, pain and numbness of the forefoot, most commonly in the second or third intermetatarsal space, which may radiate to the toes.\n\n(3) While Morton metatarsalgia attracts ICD-10-AM code G57.6, in applying this Statement of Principles the meaning of Morton metatarsalgia 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 Morton metatarsalgia\n\n(5) For the purposes of this Statement of Principles, Morton metatarsalgia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's Morton metatarsalgia.\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 Morton metatarsalgia and death from Morton metatarsalgia 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, Morton metatarsalgia or death from Morton metatarsalgia is connected with the circumstances of a person's relevant service:\n\n(1) wearing footwear which compresses the affected forefoot or increases the pressure on the ball of the affected foot, or has a high heel, for at least four hours per day on more days than not, for at least the two years before the clinical onset of Morton metatarsalgia;\n\n(2) having an injury to the foot which damages or compresses the interdigital plantar nerve within the affected intermetatarsal space, within the six months before the clinical onset of Morton metatarsalgia;\n\n(3) undergoing surgery to the foot which damages or compresses the interdigital plantar nerve within the affected intermetatarsal space, within the six months before the clinical onset of Morton metatarsalgia;\n\n(4) having a deformity of the affected foot from the specified list of deformities of the foot, which damages or compresses the interdigital plantar nerve within the affected intermetatarsal space, at the time of the clinical onset of Morton metatarsalgia;\n\nNote: specified list of deformities of the foot is defined in the Schedule 1 - Dictionary. \n\n(5) having an inflammatory arthritis which damages or compresses the interdigital plantar nerve within the affected intermetatarsal space, at the time of the clinical onset of Morton metatarsalgia;\n\n(6) wearing footwear which compresses the affected forefoot or increases the pressure on the ball of the affected foot, or has a high heel, for at least four hours per day on more days than not, for at least the two years before the clinical worsening of Morton metatarsalgia;\n\n(7) having an injury to the foot which damages or compresses the interdigital plantar nerve within the affected intermetatarsal space, within the six months before the clinical worsening of Morton metatarsalgia;\n\n(8) undergoing surgery to the foot which damages or compresses the interdigital plantar nerve within the affected intermetatarsal space, within the six months before the clinical worsening of Morton metatarsalgia;\n\n(9) having a deformity of the affected foot from the specified list of deformities of the foot, which damages or compresses the interdigital plantar nerve within the affected intermetatarsal space, at the time of the clinical worsening of Morton metatarsalgia;\n\nNote: specified list of deformities of the foot is defined in the Schedule 1 - Dictionary. \n\n(10) having an inflammatory arthritis which damages or compresses the interdigital plantar nerve within the affected intermetatarsal space, at the time of the clinical worsening of Morton metatarsalgia;\n\n(11) inability to obtain appropriate clinical management for Morton metatarsalgia.\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(6) to (11) apply only to material contribution to, or aggravation of, Morton metatarsalgia where the person's Morton metatarsalgia 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 Morton metatarsalgia —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 specified list of deformities of the foot means:\n\n(a) claw toes;\n\n(b) deformity caused by fracture of the metatarsal;\n\n(c) equinus deformity;\n\n(d) hallux rigidus;\n\n(e) hallux valgus;\n\n(f) hammer toes;\n\n(g) pes cavus; or\n\n(h) pes planus.\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":5,"scope_assessment":{"changed":false,"description":"This instrument replaces the 2010 Statement but continues to operate as a Statement of Principles linking Morton metatarsalgia (and related death) to 'relevant service' for claims under the VEA and MRCA (see ss3–5 and s4). The instrument defines the condition and sets the same class-based remit (service-connection for claims) without expressing an expanded or reduced statutory scope within the text provided."},"complexity_factors":["Standard of proof is the balance of probabilities (s8) rather than a higher medical causation standard.","Multiple discrete causative/aggravating factors with different temporal thresholds (e.g. 2 years for prolonged footwear in s9(1) and s9(6); 6 months for injury/surgery in s9(2), s9(3), s9(7), s9(8)).","Medical definition excludes peripheral neuropathy and references an ICD-10-AM code while providing its own substantive definition (s7(2)–(4)).","Includes both onset and clinical worsening pathways with conditional application depending on whether condition arose out of service (s10(2)).","Lists a specified catalogue of foot deformities that can operate as causal factors (Schedule 1 definitions).","Permits linkage to other Statements of Principles where factors overlap, creating cross-instrument dependencies (s11).","Provides for death caused by a terminal event contributed to by the condition, requiring proximate-cause analysis (s7(5) and Schedule 1 terminal event).","Replaces an earlier Statement (No. 93 of 2010), creating potential transitional interpretation issues (s4).","Includes a non‑specific factor—'inability to obtain appropriate clinical management'—which may require substantial factual inquiry and administrative discretion (s9(11)).","Applies only to claims under specific statutory provisions (s5), requiring claimants to fit into distinct statutory streams (VEA s120B or MRCA s339)."],"plain_english_summary":"This instrument sets the medical rules the Repatriation Medical Authority uses to decide if Morton metatarsalgia (Morton neuroma) or death from it is connected to a veteran's or service member's relevant service for claims under the Veterans' Entitlements Act or the Military Rehabilitation and Compensation Act. It specifies the medical definition, lists discrete causative or aggravating factors (for example prolonged use of compressive/high‑heel footwear, recent foot injury or surgery, certain foot deformities, inflammatory arthritis, or inadequate clinical management) and applies the balance of probabilities."},"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 instrument maintains its original narrow scope as a specific medical determination for a single condition (Morton metatarsalgia). It replaces a 2010 version without expanding beyond its purpose of establishing causation factors for this particular foot nerve condition in the veterans' compensation scheme."},"complexity_factors":["Moderate cross-referencing between the main instrument and Schedule 1 (Dictionary)","Dual application framework covering two different Acts (VEA and MRCA) with different service definitions","11 distinct factors with varying temporal requirements (2-year lookback vs 6-month lookback vs contemporaneous)","Bifurcated structure distinguishing between 'clinical onset' (factors 1-5) and 'clinical worsening' (factors 6-10)","Nested definitions requiring lookup in Schedule 1 for key terms like 'specified list of deformities of the foot' and 'terminal event'","Conditional logic in section 10(2) restricting certain factors to aggravation cases only","Recursive reference in section 11 requiring consultation of other Statements of Principles for related conditions"],"plain_english_summary":"This instrument sets the rules for when Australian veterans and current/former defence members can claim compensation for Morton metatarsalgia (Morton neuroma). It defines the condition for compensation purposes and replaces the 2010 version.\n\nIt lists 11 connection‑to‑service factors (e.g., prolonged tight/high‑heel footwear, recent foot injury/surgery, toe/foot deformities, inflammatory arthritis, or lack of access to treatment) and requires proof on the balance of probabilities."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-morton-metatarsalgia-balance-of-probabilities-no-78-of-2019","history":"/api/acts/statement-of-principles-concerning-morton-metatarsalgia-balance-of-probabilities-no-78-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-morton-metatarsalgia-balance-of-probabilities-no-78-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-morton-metatarsalgia-balance-of-probabilities-no-78-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-morton-metatarsalgia-balance-of-probabilities-no-78-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-morton-metatarsalgia-balance-of-probabilities-no-78-of-2019/documents"}}