{"id":"F2020L00494","name":"Statement of Principles concerning patellar tendinopathy (Reasonable Hypothesis) (No. 21 of 2020)","slug":"statement-of-principles-concerning-patellar-tendinopathy-reasonable-hypothesis-no-21-of-2020","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440466,"registerId":"F2020L00494-fast-fetch-1775956074856","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning patellar tendinopathy (Reasonable Hypothesis) (No. 21 of 2020)","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\nPATELLAR TENDINOPATHY (Reasonable Hypothesis)\n\n(No. 21 of 2020)\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 24 April 2020\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 patellar tendinopathy (Reasonable Hypothesis) (No. 21 of 2020).\n\n2 Commencement\n\n This instrument commences on 25 May 2020.\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 patellar tendinopathy No. 114 of 2011 (Federal Register of Legislation No. F2011L01743) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 patellar tendinopathy and death from patellar tendinopathy.\n\nMeaning of patellar tendinopathy\n\n(2) For the purposes of this Statement of Principles, patellar tendinopathy:\n\n(a) means an acquired clinically symptomatic condition involving inflammation or degeneration of the patellar tendon; and\n\n(b) includes:\n\n(i) degenerative distal quadriceps tendon tear or rupture;\n\n(ii) degenerative patellar tendon tear or rupture;\n\n(iii) distal quadriceps tendinitis or tendinopathy; and\n\n(iv) patellar tendinitis; and\n\n(c) excludes:\n\n(i) Osgood-Schlatter disease;\n\n(ii) patellar tendon enthesopathy;\n\n(iii) patellar tendon lateral femoral condyle friction syndrome (Hoffa fat pad impingement syndrome); and\n\n(iv) Sinding-Larsen-Johansson syndrome.\n\nNote: The symptoms of patellar tendinopathy include pain and tenderness localised to the distal quadriceps or patellar tendon at the front of the knee, and a worsening of the symptoms with physical activity.\n\n(3) While patellar tendinopathy attracts ICD‑10‑AM code M76.5, in applying this Statement of Principles the meaning of patellar tendinopathy 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 patellar tendinopathy\n\n(5) For the purposes of this Statement of Principles, patellar tendinopathy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's patellar tendinopathy.\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 patellar tendinopathy and death from patellar tendinopathy 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 patellar tendinopathy or death from patellar tendinopathy 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 at least the four weeks before the clinical onset of patellar tendinopathy;\n\n(2) undertaking weight bearing exercise involving jumping or repeated flexion and extension of the affected knee, at a minimum intensity greater than six METs for at least four hours per week, for at least the four weeks before the clinical onset of patellar tendinopathy;\n\nNote: MET is defined in the Schedule 1 - Dictionary. \n\n(3) increasing the frequency, duration or intensity of weight bearing activity involving the affected knee by at least 100 percent, to a minimum intensity of five METs for at least two hours per day, within the seven days before the clinical onset of patellar tendinopathy;\n\nNote: MET is defined in the Schedule 1 - Dictionary. \n\n(4) having direct trauma to the patellar tendon of the affected knee at the time of the clinical onset of patellar tendinopathy;\n\n(5) having gout of the patellar tendon or distal quadriceps tendon at the time of the clinical onset of patellar tendinopathy;\n\n(6) being treated with a glucocorticoid drug as specified before the clinical onset of patellar tendinopathy;\n\nNote: being treated with a glucocorticoid drug as specified is defined in the Schedule 1 - Dictionary.\n\n(7) being treated with a fluoroquinolone antibiotic within the 60 days before the clinical onset of patellar tendinopathy;\n\n(8) for distal quadriceps tendinopathy or rupture only, being treated with atorvastatin for at least three months within the one year before the clinical onset of patellar tendinopathy;\n\n(9) for patellar tendon or distal quadriceps tendon rupture only:\n\n(a) having diabetes mellitus at the time of the clinical onset of patellar tendinopathy; or\n\n(b) having chronic renal failure at the time of the clinical onset of patellar tendinopathy;\n\nNote: chronic renal failure is defined in the Schedule 1 - Dictionary. \n\n(10) running or jogging an average of at least 30 kilometres per week for at least the four weeks before the clinical worsening of patellar tendinopathy;\n\n(11) undertaking weight bearing exercise involving jumping or repeated flexion and extension of the affected knee, at a minimum intensity greater than six METs for at least four hours per week, for at least the four weeks before the clinical worsening of patellar tendinopathy;\n\nNote: MET is defined in the Schedule 1 - Dictionary. \n\n(12) increasing the frequency, duration or intensity of weight bearing activity involving the affected knee by at least 100 percent, to a minimum intensity of five METs for at least two hours per day, within the seven days before the clinical worsening of patellar tendinopathy;\n\nNote: MET is defined in the Schedule 1 - Dictionary. \n\n(13) having direct trauma to the patellar tendon of the affected knee at the time of the clinical worsening of patellar tendinopathy;\n\n(14) having gout of the patellar tendon or distal quadriceps tendon at the time of the clinical worsening of patellar tendinopathy;\n\n(15) being treated with a glucocorticoid drug as specified before the clinical worsening of patellar tendinopathy;\n\nNote: being treated with a glucocorticoid drug as specified is defined in the Schedule 1 - Dictionary.\n\n(16) being treated with a fluoroquinolone antibiotic within the 60 days before the clinical worsening of patellar tendinopathy;\n\n(17) for distal quadriceps tendinopathy or rupture only, being treated with atorvastatin for at least three months within the one year before the clinical worsening of patellar tendinopathy;\n\n(18) inability to obtain appropriate clinical management for patellar tendinopathy.\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(10) to 9(18) apply only to material contribution to, or aggravation of, patellar tendinopathy where the person's patellar tendinopathy 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\n In this instrument:\n\n being treated with a glucocorticoid drug as specified means:\n\n(a) being treated with prednisolone, in the combinations of mode of administration, dose, duration of treatment and proximity to the clinical onset or worsening of patellar tendinopathy, as specified in Table 1 below; or\n\n(b) being treated as specified in Table 1 with a glucocorticoid drug other than prednisolone in doses having an efficacy equivalent to prednisolone, that being calculated for the drugs listed in accordance with Table 2 below.\n\n Table 1\n\n- Drug Mode Dose Minimum duration of treatment Proximity to clinical onset or worsening\n- Prednisolone IV, IM, O ≥ 0.5 grams over 6 months 6 months within the 3 years\n- ≥ 3 grams NS within the 5 years\n- ≥ 10 grams NS NS\n- Injection in tendonregion ≥ 1 injection NS within the 2 weeks\n\n\nAbbreviations: IV = intravenous; IM = intramuscular; O = oral; NS = not specified.\n\n Table 2\n\n| Glucocorticoid drug | Dose efficacy equivalence to prednisolone |\n| --- | --- |\n| cortisone | 5 |\n| hydrocortisone | 4 |\n| prednisolone | 1 |\n| prednisone | 1 |\n| methylprednisolone | 0.8 |\n| triamcinolone | 0.8 |\n| paramethasone | 0.4 |\n| dexamethasone | 0.15 |\n| betamethasone | 0.12 |\n\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 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 patellar tendinopathy—see subsection 7(2).\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 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":7,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2011 Statement (s.4) and replaces it with updated criteria that: clarify the medical meaning and exclusions for patellar tendinopathy (s.7(2)–(3)); include death contributed to by the condition (s.7(5)); add quantified activity and MET thresholds and defined time windows for onset and worsening (s.9; Schedule 1); and set out detailed glucocorticoid dose equivalences (Schedule 1 Tables 1–2). It therefore alters the operational scope and evidentiary thresholds for linking the condition to relevant service (see s.5, s.9)."},"complexity_factors":["Technical medical definitions and exclusions for patellar tendinopathy (s.7(2)–(4))","Multiple quantitative exposure thresholds (e.g. running 30 km/week; MET intensity and hours; 100% activity increase) (s.9(1)–(3),(10)–(12))","Separate rules for clinical onset versus clinical worsening, and for material contribution/aggravation (s.9, s.10(2))","Time windows and proximity requirements for exposures and drug treatments (s.9, Schedule 1 Table 1)","Detailed glucocorticoid dosing and equivalence tables requiring dose-conversion calculations (Schedule 1 Table 1–2)","Specific drug- and disease-related risk factors (fluoroquinolones, atorvastatin, diabetes, chronic renal failure) with varying applicability (s.9(6)–(9),(15)–(17))","Cross-reference to other Statements of Principles where overlapping injuries/diseases are involved (s.11)","Application limited to claims under specified statutory sections (s.5) and subject to the statutory reasonable‑hypothesis test","Inclusion of death from a terminal event contributed to by the condition, requiring causation assessment (s.7(5))","Operational complexity for decision-makers and claimants in proving the temporal and service‑related links between listed factors and the condition"],"plain_english_summary":"This Statement of Principles sets the medical rules used to link patellar tendinopathy (and death partly caused by it) to a person’s \"relevant service\" for claims under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. It replaces the 2011 Statement and commenced 25 May 2020.\n\nIt defines the condition, sets quantified activity and drug-related risk thresholds and exclusions, and requires claimants to show at least one listed factor connected to service (section 9), creating measurable evidentiary and compliance requirements for claimants, clinicians and decision‑makers."},"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"This is a standard replacement instrument within the established Repatriation Medical Authority framework. It updates the 2011 version with current medical evidence but does not expand beyond the original purpose of determining service connection for patellar tendinopathy claims. The scope remains tightly focused on this specific knee condition and its relationship to defined military service."},"complexity_factors":["18 distinct factors with varying applicability (some limited to 'clinical onset', some to 'clinical worsening', some to specific sub-types like 'distal quadriceps tendinopathy only')","Nested conditional logic: Factor 8 applies only to specific sub-types; Factor 9 applies only to rupture cases and requires diabetes or renal failure; Factor 18 applies only to worsening cases","7 defined terms in Schedule 1, including complex medical definitions (chronic renal failure requiring GFR calculations or dialysis status; glucocorticoid equivalence tables)","Cross-referencing requirement in section 11: if a factor refers to another disease covered by a separate Statement of Principles, that entire instrument applies","Technical medical thresholds: MET calculations (metabolic equivalents), specific drug dosages with equivalence ratios (Table 2), time windows (60 days, 3 years, 5 years), and anatomical distinctions (excluding Osgood-Schlatter disease, Sinding-Larsen-Johansson syndrome)","Dual legislative framework application: must operate under both VEA and MRCA with different service definitions"],"plain_english_summary":"This instrument updates the medical rules for claiming compensation for patellar tendinopathy (jumper’s knee), replacing the 2011 guidance. It sets 18 specific service‑related factors that, if proven, create a “reasonable hypothesis” linking the condition to military service and covers both new onset and worsening of pre‑existing cases.\n\nIt affects veterans, current/former defence members, and dependants claiming under the VEA or MRCA — and functions as the gatekeeper for entitlement 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-patellar-tendinopathy-reasonable-hypothesis-no-21-of-2020","history":"/api/acts/statement-of-principles-concerning-patellar-tendinopathy-reasonable-hypothesis-no-21-of-2020/history","analysis":"/api/acts/statement-of-principles-concerning-patellar-tendinopathy-reasonable-hypothesis-no-21-of-2020/analysis","conflicts":"/api/acts/statement-of-principles-concerning-patellar-tendinopathy-reasonable-hypothesis-no-21-of-2020/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-patellar-tendinopathy-reasonable-hypothesis-no-21-of-2020/important-cases","documents":"/api/acts/statement-of-principles-concerning-patellar-tendinopathy-reasonable-hypothesis-no-21-of-2020/documents"}}