{"id":"F2019L01098","name":"Statement of Principles concerning Morton metatarsalgia (Reasonable Hypothesis) (No. 77 of 2019)","slug":"statement-of-principles-concerning-morton-metatarsalgia-reasonable-hypothesis-no-77-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440209,"registerId":"F2019L01098-fast-fetch-1775955924021","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning Morton metatarsalgia (Reasonable Hypothesis) (No. 77 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 (Reasonable Hypothesis)\n\n(No. 77 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 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 (Reasonable Hypothesis) (No. 77 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning Morton's metatarsalgia No. 92 of 2010 (Federal Register of Legislation No. F2010L02848) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that Morton metatarsalgia and death from Morton metatarsalgia 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 Morton metatarsalgia or death from Morton metatarsalgia 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 one year 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 one year 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 one year 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 one year 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 one year 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 one year 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(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 Morton metatarsalgia—see subsection 7(2).\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\nrelevant 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 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\nVEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard Statement of Principles instrument that operates within its intended scope under section 196B(2) of the Veterans' Entitlements Act 1986. It replaces a 2010 version of the same instrument (No. 92 of 2010) without expanding beyond the established framework for determining service-related medical conditions. The structure and purpose remain consistent with other Repatriation Medical Authority determinations."},"complexity_factors":["Moderate cross-referencing between main sections and Schedule 1 Dictionary (6 defined terms)","Dual application framework requiring understanding of two separate Acts (VEA and MRCA)","Parallel structure with near-identical factors repeated for 'clinical onset' vs 'clinical worsening' (subsections 9(1)-(5) mirror 9(6)-(10))","Conditional logic in section 10(2) restricting application of certain factors to pre-existing conditions aggravated by service","Nested definitions requiring lookup (e.g., 'specified list of deformities' defined separately in Dictionary)","Specific temporal requirements ('within one year', 'at least four hours per day on more days than not, for at least the one year')","Reference to external medical classification system (ICD-10-AM Tenth Edition)"],"plain_english_summary":"This instrument replaces the 2010 rules and defines when Morton metatarsalgia (Morton neuroma) counts as service-related for compensation. It sets the medical criteria and the types of circumstances that must link the condition to military service.\n\nIt affects veterans and current/former defence members claiming under the Veterans' Entitlements Act 1986 or the Military Rehabilitation and Compensation Act 2004, and functions as the Department of Veterans' Affairs’ rulebook for eligibility."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":false,"description":"This instrument repeals the earlier Statement of Principles No. 92 of 2010 (s4) and applies to claims under section 120A of the VEA or section 338 of the MRCA (s5). It defines Morton metatarsalgia, lists qualifying factors for onset and worsening, and specifies connection to relevant service (s7, s9, s10). The text itself does not state an explicit broadening or narrowing of the covered class compared with the repealed instrument; it replaces the prior instrument as the operative Statement."},"complexity_factors":["Medical definition specificity and exclusion (Morton metatarsalgia defined; peripheral neuropathy excluded) — s7(2)","Use of ICD-10-AM code as a cross‑reference while prescribing a bespoke definition — s7(3)–(4)","Evidentiary standard framed as a ‘reasonable hypothesis’ supported by RMA view of ‘sound medical‑scientific evidence’ — s3 and s8","List of discrete, technical causal factors with precise timing and exposure requirements (e.g. footwear ≥4 hours/day for ≥1 year before onset) creating factual proof burdens — s9(1), s9(6)","Separate factor sets for clinical onset versus clinical worsening and a rule limiting worsening factors to pre‑existing cases — s9 and s10(2)","Requirement that any listed factor be related to the person's relevant service, i.e. a causation/connection element — s10(1)","Cross‑reference to other Statements of Principles where a factor concerns another injury/disease, creating dependency on other instruments — s11","Defined technical terms and enumerated lists in the Schedule (relevant service categories; specified deformities; terminal event) increase interpretive steps — Schedule 1","Inclusion of non‑specific factor 'inability to obtain appropriate clinical management' which is open to factual and administrative interpretation — s9(11)","Repeal of an earlier Statement of Principles (No. 92 of 2010) requires administrators to substitute this instrument’s criteria when assessing claims — s4"],"plain_english_summary":"**What this does:** Establishes a medical definition of Morton metatarsalgia (Morton neuroma) and lists the specific medical and service‑related factors that, if present, are sufficient to raise a reasonable hypothesis that the condition (or death from it) is connected to a person's military service. \n**Who it affects and why it matters:** Affects veterans and current/former members claiming under the VEA or MRCA. It determines which clinical facts and service circumstances can support an entitlement decision and thereby shapes evidence and proof needs."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-morton-metatarsalgia-reasonable-hypothesis-no-77-of-2019","history":"/api/acts/statement-of-principles-concerning-morton-metatarsalgia-reasonable-hypothesis-no-77-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-morton-metatarsalgia-reasonable-hypothesis-no-77-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-morton-metatarsalgia-reasonable-hypothesis-no-77-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-morton-metatarsalgia-reasonable-hypothesis-no-77-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-morton-metatarsalgia-reasonable-hypothesis-no-77-of-2019/documents"}}