{"id":"F2018L00855","name":"Statement of Principles concerning olecranon bursitis (Balance of Probabilities) (No. 64 of 2018)","slug":"statement-of-principles-concerning-olecranon-bursitis-balance-of-probabilities-no-64-of-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439666,"registerId":"F2018L00855-fast-fetch-1775955604003","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning olecranon bursitis (Balance of Probabilities) (No. 64 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\nOLECRANON BURSITIS (Balance of Probabilities)\n\n(No. 64 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:
|\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 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 olecranon bursitis (Balance of Probabilities) (No. 64 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 olecranon bursitis and death from olecranon bursitis.\n\nMeaning of olecranon bursitis\n\n(2) For the purposes of this Statement of Principles, olecranon bursitis means inflammation or infection of the bursa overlying the olecranon process of the ulna.\n\nNote: Typical features of olecranon bursitis are pain, tenderness, redness, swelling and thickening of the bursa and skin in the region of the external elbow.\n\n(3) While olecranon bursitis attracts ICD‑10‑AM code M70.2, in applying this Statement of Principles the meaning of olecranon 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 olecranon bursitis\n\n(5) For the purposes of this Statement of Principles, olecranon bursitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's olecranon 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 olecranon bursitis and death from olecranon 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, olecranon bursitis or death from olecranon bursitis is connected with the circumstances of a person's relevant service:\n\n(1) having a bacterial, fungal or algal infection involving the affected bursa at the time of the clinical onset of olecranon bursitis;\n\n(2) having trauma to the external elbow of the affected side in the 30 days before the clinical onset of olecranon bursitis;\n\nNote: Examples of types of trauma include cuts, abrasions and lacerations of the affected elbow, repeated rubbing or knocking of the affected elbow, needle aspiration of the affected olecranon bursa and injection of the affected olecranon bursa with corticosteroids.\n\n(3) having surgery to the external elbow of the affected side in the 30 days before the clinical onset of olecranon bursitis;\n\n(4) for septic olecranon bursitis only, being in an immunocompromised state as specified at the time of the clinical onset of olecranon bursitis;\n\nNote: immunocompromised state as specified is defined in the Schedule 1 - Dictionary. \n\n(5) having a disorder from the specified list of disorders at the time of the clinical onset of olecranon bursitis;\n\nNote: specified list of disorders is defined in the Schedule 1 - Dictionary. \n\n(6) having psoriasis, localised sclerosis, atopic dermatitis or another inflammatory skin disorder, where the skin disorder involves the skin of the extensor surface of the affected elbow, at the time of the clinical onset of olecranon bursitis;\n\n(7) being treated with a tyrosine kinase inhibitor within the 30 days before the clinical onset of olecranon bursitis;\n\n(8) having a bacterial, fungal or algal infection involving the affected bursa at the time of the clinical worsening of olecranon bursitis;\n\n(9) having trauma to the external elbow of the affected side in the 30 days before the clinical worsening of olecranon bursitis;\n\nNote: Examples of types of trauma include cuts, abrasions and lacerations of the affected elbow, repeated rubbing or knocking of the affected elbow, needle aspiration of the affected olecranon bursa and injection of the affected olecranon bursa with corticosteroids.\n\n(10) having surgery to the external elbow of the affected side in the 30 days before the clinical worsening of olecranon bursitis;\n\n(11) for septic olecranon bursitis only, being in an immunocompromised state as specified at the time of the clinical worsening of olecranon bursitis;\n\nNote: immunocompromised state as specified is defined in the Schedule 1 - Dictionary. \n\n(12) having a disorder from the specified list of disorders at the time of the clinical worsening of olecranon bursitis;\n\nNote: specified list of disorders is defined in the Schedule 1 - Dictionary. \n\n(13) having psoriasis, localised sclerosis, atopic dermatitis or another inflammatory skin disorder, where the skin disorder involves the skin of the extensor surface of the affected elbow, at the time of the clinical worsening of olecranon bursitis;\n\n(14) being treated with a tyrosine kinase inhibitor within the 30 days before the clinical worsening of olecranon bursitis;\n\n(15) inability to obtain appropriate clinical management for olecranon 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(8) to 8(15) apply only to material contribution to, or aggravation of, olecranon bursitis where the person's olecranon 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 dihydrate, 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, tumour necrosis factor-α inhibitors and chemotherapeutic agents used for the treatment of cancer.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n olecranon bursitis—see subsection 6(2).\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 disorders means:\n\n(a) diabetes mellitus;\n\n(b) gout, pseudogout or other crystal-induced arthropathy; or\n\n(c) rheumatoid arthritis.\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":{"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":false,"description":"This SOP confines its scope to establishing which medical factors and service links are sufficient, on the balance of probabilities, to connect olecranon bursitis (and death from it) with relevant service under the VEA or MRCA (ss4,6,7,8). It does not expand beyond that adjudicative purpose into unrelated subject matter, nor does it materially broaden the class of claimants beyond those eligible under the existing VEA/MRCA definitions of relevant service. Therefore it has not grown significantly beyond its original, adjudicative purpose."},"complexity_factors":["15 discrete factors listed in section 8 (some apply to onset, some to worsening)","Approximately 11 defined terms in Schedule 1 (e.g. immunocompromised state, chronic renal failure, specified list of disorders, terminal event, relevant service)","Multiple 30‑day temporal limits for onset/worsening (s8(2),(3),(7),(9),(10),(14))","Septic‑specific conditions (different test for septic olecranon bursitis: s8(4),(11) with Schedule definitions)","Cross‑reference to other Statements of Principles where a factor refers to another disease (s10), requiring consultation of other instruments","Relationship‑to‑service qualification that limits some factors to cases where bursitis pre‑existed service or occurred before/during but not arising out of service (s9(2))","Straightforward definition of the medical condition (s6) reduces ambiguity"],"plain_english_summary":"**What this instrument does**\n\n- This is a Statement of Principles (SOP) about olecranon bursitis (inflammation or infection of the bursa over the elbow) and death that is contributed to by that condition (see s6).\n\n- It sets out the medical and factual circumstances that, on the balance of probabilities, must exist for a decision‑maker to say a veteran’s olecranon bursitis is connected with their relevant service for the purposes of the Veterans' Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA) (see ss4, 6 and 7).\n\n**Who is affected**\n\n- Veterans and current/former members of the Australian Defence Force who make claims under the VEA or MRCA for olecranon bursitis or for death from olecranon bursitis (s4). \n- Medical practitioners and decision‑makers who provide or assess medical evidence for those claims.\n\n**How it works, mechanically**\n\n- The SOP gives a plain medical definition of olecranon bursitis for this instrument (s6(2)) and confirms the institutional code (ICD‑10‑AM) is not the operative definition (s6(3)–(4)).\n\n- Section 8 lists the specific factors (15 items) that must be present for the condition (or death from it) to be considered connected with service on the balance of probabilities. At least one of those factors must exist.\n\n Key listed factors include:\n - a bacterial, fungal or algal infection in the affected bursa at clinical onset (s8(1));\n - trauma to the external elbow within 30 days before clinical onset (s8(2)) — examples given include cuts, abrasions, repeated rubbing, needle aspiration and corticosteroid injection (note to s8(2));\n - surgery to the external elbow within 30 days before clinical onset (s8(3));\n - being immunocompromised for septic bursitis (s8(4) and Schedule definitions);\n - having specified systemic disorders (diabetes, gout/pseudogout/other crystal arthropathy, rheumatoid arthritis) at onset (s8(5) and Schedule);\n - inflammatory skin disorders affecting the extensor surface of the elbow (s8(6));\n - treatment with a tyrosine kinase inhibitor within 30 days before onset (s8(7));\n - analogous factors for clinical worsening (s8(8)–(14));\n - inability to obtain appropriate clinical management (s8(15)).\n\n- Section 9 requires that any of those factors be related to the person's relevant service. Some factors (s8(8)–(15)) are limited to cases where the bursitis was suffered or contracted before or during (but did not arise out of) service (see s9(2)).\n\n- If a listed factor relates to another medical condition that already has its own SOP, the SOP for that other condition applies as that SOP reads from time to time (s10).\n\n**Official rationale**\n\n- The Repatriation Medical Authority states that medical evidence supports a finding that olecranon bursitis and death from it can be related to relevant service on the balance of probabilities (s7). That is, the SOP identifies the plausible medical links between service exposures/conditions and the condition.\n\n**Practical effects, incentives and administrative consequences**\n\n- Who decides and who pays: The SOP is used by decision‑makers administering VEA/MRCA claims (for example, the Department of Veterans’ Affairs) to decide entitlement. If accepted, compensation or services payable under those Acts would be funded from government programs established under the Acts (see s4 and s7 for context).\n\n- Burden of proof and evidence: Claimants must establish that at least one listed factor existed and was related to their relevant service. This shifts the practical evidentiary work onto claimants to provide medical records, history of trauma, documentation of infections, medication records (e.g. tyrosine kinase inhibitors) or proof of inability to access clinical care (s8, s9). Medical practitioners will be asked to provide targeted evidence on those items.\n\n- Time windows and causation rules: Several factors require temporal proximity (commonly 30 days before clinical onset or worsening). If an exposure falls outside that window, it will not satisfy the corresponding factor (s8(2), s8(3), s8(7), s8(9)–(10), s8(14)). This creates clear bright‑line rules but can exclude service contributions that are temporally remote.\n\n- Interaction with other conditions: Where the SOP points to another disease (for example diabetes or gout), the SOP for that disease may also apply and take precedence or supplement the assessment (s10). This creates a cross‑reference system that can require consultation of multiple SOPs and medical criteria.\n\n- Treatment and clinical practice touchpoints: The text explicitly counts some clinical interventions (needle aspiration, corticosteroid injection) as examples of trauma (notes to s8(2) and s8(9)). In assessment terms, documented diagnostic or therapeutic procedures may therefore support a claim. Conversely, absence of documentation of such procedures may make a claim harder to establish.\n\n- Administrative load and decision complexity: The instrument is concise, but decision‑makers must verify clinical onset/worsening dates, the presence of listed infections or disorders (using defined medical thresholds in the Schedule), medication and immunosuppression status, and the relationship to service. Where factors refer to conditions that themselves have SOPs, decision‑makers must read and apply those SOPs too (s10). This increases casework complexity modestly.\n\n- Concentration of benefits and costs: The beneficiaries are a specific, identifiable group of claimants with elbow bursitis and the particular listed factors. Costs (if claims are accepted) are borne by the statutory compensation schemes; the SOP itself creates no direct market regulation.\n\n**Implementation risks and discretion**\n\n- Medical judgement and records quality are key: Determinations will depend on clinical records and expert interpretation of ‘‘clinical onset’’ and ‘‘clinical worsening’’. Poor records increase uncertainty and appeals risk.\n\n- Ongoing change through cross‑references: Because s10 applies other SOPs ‘‘as in force from time to time’’, future changes to those SOPs can affect how this SOP operates without amendment to this instrument.\n\n**Bottom line**\n\n- This SOP specifies the concrete medical and temporal factors that, if supported by evidence and related to relevant service, will satisfy the balance‑of‑probabilities test for olecranon bursitis (or death from it) in claims under the VEA/MRCA. It narrows entitlement decisions to a defined set of conditions and documented exposures, sets short temporal windows for certain causes, and requires factual linkage between those factors and the person’s relevant service (see ss6–10 and the Schedule)."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains its original narrow scope. It addresses a single specific medical condition (olecranon bursitis) under established statutory frameworks. The content is consistent with the standard template used for Repatriation Medical Authority Statements of Principles, with no evidence of scope creep beyond the original purpose of determining service connection for this particular elbow condition."},"complexity_factors":["15 distinct causal factors with parallel structure (8 factors for clinical onset, 7 for clinical worsening)","Multiple defined terms in Schedule 1 (12 definitions including nested definitions)","Cross-references to external legislation (VEA and MRCA) and medical classification systems (ICD-10-AM)","Conditional logic: factor 4 and 11 apply 'for septic olecranon bursitis only'","Temporal limitations (30-day windows for trauma, surgery, and drug treatment)","Incorporation by reference to other Statements of Principles in section 10","Dual application structure — distinguishes between conditions arising during service versus pre-existing conditions aggravated by service"],"plain_english_summary":"This Statement of Principles sets the medical rules for linking olecranon bursitis (elbow swelling) to Australian military service, guiding claims under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. It affects current and former ADF members and the Repatriation Medical Authority that assesses claims.\n\nIt lists 15 specific service-related factors (any one can suffice) and uses the \"balance of probabilities\" test, giving clearer, more claim-favourable criteria for compensation decisions."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-olecranon-bursitis-balance-of-probabilities-no-64-of-2018","history":"/api/acts/statement-of-principles-concerning-olecranon-bursitis-balance-of-probabilities-no-64-of-2018/history","analysis":"/api/acts/statement-of-principles-concerning-olecranon-bursitis-balance-of-probabilities-no-64-of-2018/analysis","conflicts":"/api/acts/statement-of-principles-concerning-olecranon-bursitis-balance-of-probabilities-no-64-of-2018/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-olecranon-bursitis-balance-of-probabilities-no-64-of-2018/important-cases","documents":"/api/acts/statement-of-principles-concerning-olecranon-bursitis-balance-of-probabilities-no-64-of-2018/documents"}}