{"id":"F2024L00219","name":"Statement of Principles concerning Osteomyelitis (Reasonable Hypothesis) (No. 23 of 2024)","slug":"statement-of-principles-concerning-osteomyelitis-reasonable-hypothesis-no-23-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442291,"registerId":"F2024L00219-fast-fetch-1775957342244","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning Osteomyelitis (Reasonable Hypothesis) (No. 23 of 2024)","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\nOSTEOMYELITIS (Reasonable Hypothesis)\n\n(No. 23 of 2024)\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 22 February 2024.\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:
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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 osteomyelitis (Reasonable Hypothesis) (No. 23 of 2024).\n\n2 Commencement\n\n This instrument commences on 26 March 2024.\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 osteomyelitis No. 90 of 2014 (Federal Register of Legislation No. F2014L01380) made under subsections 196B(2) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 osteomyelitis and death from osteomyelitis.\n\nMeaning of osteomyelitis\n\n(2) For the purposes of this Statement of Principles, osteomyelitis:\n\n(a) means inflammation of bone caused by infection; and\n\n(b) excludes chondritis, septic arthritis and discitis.\n\nNote 1: Osteomyelitis can affect all bones including the jaw, bones of the inner ear, and vertebrae.\n\nNote 2: Osteomyelitis can be caused by bacteria, fungi, some parasites of the Echinococcus, Trichinella and Schistosoma genus.\n\n(3) While osteomyelitis attracts ICD‑10‑AM codes M90.2, M86, M46.2 and K10.2, in applying this Statement of Principles the meaning of osteomyelitis 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 osteomyelitis\n\n(5) For the purposes of this Statement of Principles, osteomyelitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's osteomyelitis.\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 osteomyelitis and death from osteomyelitis 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 osteomyelitis or death from osteomyelitis with the circumstances of a person's relevant service:\n\n(1) having a wound, laceration, other injury or disease disrupting the skin or mucosa at the site or adjacent to the site of osteomyelitis, within the 2 years before the clinical onset of osteomyelitis;\n\nNote: Examples of injuries that disrupt the skin include penetrative injuries, compound fractures, burns or pressure ulcers. Examples of diseases that disrupt the skin include chronic ischaemia or diabetes mellitus.\n\n(2) having a dental, medical or surgical procedure which breaches the skin or mucosa at the site or adjacent to the site of osteomyelitis within the 2 years before the clinical onset of osteomyelitis;\n\nNote: Examples of procedures that breach the skin or mucosa include lumbar puncture, epidural anaesthesia and tooth extraction.\n\n(3) having septicaemia, bacteraemia, systemic fungal infection or parasitic infection with Echinococcus granulosus, Trichinella spiralis, or Schistosoma species within the 2 years before the clinical onset of osteomyelitis;\n\nNote: Echinococcus granulosus, Trichinella spiralis, and Schistosoma species are types of parasitic worms.\n\n(4) having a foreign body at the site or adjacent to the site of osteomyelitis at the time of the clinical onset of osteomyelitis;\n\nNote: Examples of foreign bodies associated with osteomyelitis include internal fixation devices, joint replacements, vascular grafts, shrapnel and bullets.\n\n(5) having diabetes mellitus at the time of the clinical onset or clinical worsening of osteomyelitis;\n\n(6) having one of the following chronic medical conditions before the clinical onset or clinical worsening of osteomyelitis:\n\n(a) chronic renal failure;\n\n(b) cirrhosis of the liver;\n\n(c) Crohn disease; or\n\n(d) sickle cell disorder.\n\nNote: chronic renal failure is defined in the Schedule -1 Dictionary.\n\n(7) having chronic ischaemia of the affected lower limb from chronic venous insufficiency or atherosclerotic peripheral vascular disease at the time of the clinical onset or clinical worsening of osteomyelitis;\n\n(8) having a substantially compromised immune system due to:\n\n(a) chronic renal failure;\n\n(b) haematological malignancy;\n\n(c) infection with human immunodeficiency virus;\n\n(d) severe malnutrition;\n\n(e) solid organ, stem cell or bone marrow transplantation; or\n\n(f) taking an immunosuppressive drug;\n\nat the time of the clinical onset or clinical worsening of osteomyelitis;\n\nNote 1: chronic renal failure and immunosuppressive drug and severe malnutrition are defined in the Schedule -1 Dictionary.\n\n(9) undergoing a course of radiotherapy for cancer, where the affected site was in the field of radiation, before the clinical onset of osteomyelitis;\n\n(10) having osteonecrosis at the site of osteomyelitis before the clinical onset of osteomyelitis;\n\n(11) inability to obtain appropriate clinical management for osteomyelitis before the clinical worsening of osteomyelitis.\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, osteomyelitis where the person's osteomyelitis 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 Body Mass Index (BMI) means W/H2 and where:\n\n (a) W is the person's weight in kilograms; and\n\n (b) H is the person's height in metres.\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 3 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 immunosuppressive drug means:\n\n(a) corticosteroids other than inhaled or topical corticosteroids;\n\n(b) drugs used to prevent transplant rejection;\n\n(c) tumour necrosis factor-α inhibitors; or\n\n(d) chemotherapeutic agents used for the treatment of cancer.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n osteomyelitis—see subsection 7(2).\n\n protein-calorie malnutrition means undernourishment due to inadequate intake, absorption or utilisation of protein or energy foods.\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 severe malnutrition means having protein-calorie malnutrition associated with a body mass index (BMI) less than or equal to 18.5 kg/m2.\n\nNote : Body Mass Index (BMI) and protein-calorie malnutrition 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_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 expired Statement of Principles under the veterans' compensation scheme. It maintains the same fundamental structure and purpose as its 2014 predecessor: establishing medical factors for linking osteomyelitis to service. The scope remains tightly focused on this specific bone infection condition and its relationship to military service claims. No significant expansion beyond the original intent is evident."},"complexity_factors":["Moderate cross-referencing: 9 defined terms in Schedule 1 Dictionary, with some definitions nested (e.g., 'severe malnutrition' depends on 'protein-calorie malnutrition' and 'BMI')","Temporal conditions: Multiple factors include specific time windows ('within 2 years before', 'at the time of', 'before') that must be precisely applied","Dual application structure: Factors apply to both 'clinical onset' and 'clinical worsening' with different rules for each (section 10(2) creates a conditional limitation)","External legislative references: Requires understanding of 'relevant service' categories across two separate Acts (VEA and MRCA) with six distinct service types listed","Incorporation by reference: ICD-10-AM coding system (Tenth Edition, 2017) is imported for classification purposes","Cascading definitions: Section 11 creates a mechanism where other Statements of Principles automatically apply if referenced factors appear"],"plain_english_summary":"This instrument defines the medical criteria for linking osteomyelitis (and death from it) to military service for veterans’ compensation claims. It lists 11 clinical factors that, if present and connected to service, create a “reasonable hypothesis” that infection was caused or worsened by service — triggering the benefit-of-the-doubt standard. It affects veterans, peacekeepers and Defence members claiming under VEA or MRCA, and replaces the 2014 Statement of Principles."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2014 Statement (s4) and replaces it with an updated Statement that (a) restates and narrows the definition and exclusions for osteomyelitis (s7(2)–(4)), (b) explicitly includes death from osteomyelitis (s7(5)), (c) specifies a revised list of qualifying factors and a 2‑year temporal window for many of them (s9), and (d) clarifies interaction with other Statements (s11). Those textual changes alter which medical histories will meet the \"reasonable hypothesis\" test and therefore change the practical scope of claims covered under the VEA/MRCA framework."},"complexity_factors":["Medical detail and terminology (osteomyelitis definition, exclusions, ICD‑10‑AM codes) — see s7(2)–(4)","Multiple specific medical and temporal criteria that can independently satisfy the threshold (e.g. \"within 2 years\", presence at clinical onset) — see s9","Interaction and cross‑reference with other Statements of Principles when factors overlap — see s11","Defined legal and clinical terms in Schedule 1 that affect application (e.g. relevant service, chronic renal failure, terminal event) — see Schedule 1","Legal evidentiary threshold is procedural ('reasonable hypothesis') rather than causal proof, requiring judgment by the Authority — see s9 and s8","Relationship-to-service requirement and limits on aggravation/worsening scenarios add interpretive complexity — see s10","Repeal and replacement of an earlier instrument creates transitional/consistency issues for prior determinations — see s4"],"plain_english_summary":"This instrument replaces the previous Statement of Principles for osteomyelitis and sets the medical rules the Repatriation Medical Authority uses to decide when osteomyelitis (or death from it) can be reasonably linked to military service. It defines osteomyelitis, lists specific medical and timing-based factors (for example wounds or procedures near the site, systemic infection, foreign bodies, chronic diseases, immunosuppression, radiotherapy) and requires at least one such factor related to the person's service to raise a \"reasonable hypothesis.\" \n\nIt affects veterans and service members making claims under the Veterans' Entitlements Act or the Military Rehabilitation and Compensation Act and relies on clinical timing, defined terms and cross-references to other Statements to determine entitlement."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-osteomyelitis-reasonable-hypothesis-no-23-of-2024","history":"/api/acts/statement-of-principles-concerning-osteomyelitis-reasonable-hypothesis-no-23-of-2024/history","analysis":"/api/acts/statement-of-principles-concerning-osteomyelitis-reasonable-hypothesis-no-23-of-2024/analysis","conflicts":"/api/acts/statement-of-principles-concerning-osteomyelitis-reasonable-hypothesis-no-23-of-2024/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-osteomyelitis-reasonable-hypothesis-no-23-of-2024/important-cases","documents":"/api/acts/statement-of-principles-concerning-osteomyelitis-reasonable-hypothesis-no-23-of-2024/documents"}}