{"id":"F2024L01044","name":"Statement of Principles concerning pathological fracture (Balance of Probabilities) (No. 65 of 2024)","slug":"statement-of-principles-concerning-pathological-fracture-balance-of-probabilities-no-65-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442532,"registerId":"F2024L01044-fast-fetch-1775957509818","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning pathological fracture (Balance of Probabilities) (No. 65 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\nPATHOLOGICAL FRACTURE (Balance of Probabilities)\n\n(No. 65 of 2024)\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 20 August 2024.\n\n \n\n \n\n \n\n \n\n \n\n|
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Professor Terence Campbell AM
Chairperson
by and on behalf of
The Repatriation Medical Authority |\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 pathological fracture (Balance of Probabilities) (No. 65 of 2024).\n\n2 Commencement\n\n This instrument commences on 24 September 2024.\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 fracture No. 95 of 2015 (Federal Register of Legislation No. F2015L01343) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 pathological fracture and death from pathological fracture.\n\nMeaning of pathological fracture\n\n(2) For the purposes of this Statement of Principles, pathological fracture:\n\n(a) means an acquired break of bone as a result of an applied force that ordinarily would not cause bone breakage in a healthy bone; and\n\n(b) includes:\n\n(i) acute vascular shock, acute compartment syndrome, or fat embolism resulting from the fractured bone;\n\n(ii) pathological fracture or insufficiency stress fracture due to focal bone weakness;\n\n(iii) pathological fracture or insufficiency stress fracture due to global bone weakness;\n\n(iv) periosteal, muscular, fascial, skin, nerve or vascular damage directly caused by the displaced fractured bone; and\n\n(v) wound infection as a result of penetration of the skin by bony fracture fragments (compound fracture).\n\nNote 1: Pathological fractures are also known as secondary fractures, spontaneous fractures, fragility fractures, and minimal trauma fractures.\n\nNote 2: Bone weakness includes decreased bone mineral density (osteoporosis), disarrangement of bone structure, and the presence of additional bone pathology.\n\nNote 3: Clinical worsening could include fracture non-union but not an additional fracture. An additional fracture would require further invocation of the fracture SoPs.\n\nDeath from pathological fracture\n\n(3) For the purposes of this Statement of Principles, pathological fracture, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's pathological fracture.\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 pathological fracture and death from pathological fracture 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, pathological fracture or death from pathological fracture is connected with the circumstances of a person's relevant service:\n\n(1) having one of the following medical conditions involving the affected region of bone at the time of clinical onset:\n\n(a) benign neoplasm;\n\n(b) malignant primary or secondary neoplasm;\n\n(c) osteomalacia;\n\n(d) osteomyelitis;\n\n(e) osteonecrosis;\n\n(f) osteoporosis; or\n\n(g) Paget disease of bone;\n\nNote: osteomalacia and osteonecrosis are defined in the Schedule 1 - Dictionary.\n\n(2) having ankylosing spondylitis at the time of clinical onset of vertebral pathological fracture;\n\n(3) smoking at least 5 cigarettes per day, or the equivalent thereof in other tobacco products, during treatment for fracture prior to fracture non-union;\n\nNote 1: One gram of tobacco is considered to be equivalent to one cigarette.\n\nNote 2: Fracture non-union is considered to be a clinical worsening of the pathological fracture.\n\n(4) having diabetes mellitus at the time of the fracture non-union;\n\nNote: Fracture non-union is considered to be a clinical worsening of the pathological fracture.\n\n(5) inability to obtain appropriate clinical management for pathological fracture before clinical worsening.\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, pathological fracture where the person's pathological fracture 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 MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n osteomalacia means a disease of bone in which there is a reduction in the mineralisation of its organic matrix and bone softening, due to a deficiency of vitamin D or problems with the metabolism of vitamin D.\n\n osteonecrosis means a disease of bone where death of bone tissue occurs as a result of the temporary or permanent loss of blood supply to bone. Osteonecrosis is also known as avascular necrosis, aseptic necrosis or ischaemic necrosis.\n\n pathological fracture—see subsection 7(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 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 instrument maintains the established scope of Repatriation Medical Authority Statements of Principles. It replaces a 2015 instrument on the same topic (fractures) without expanding into new substantive areas. The structure — covering definition, causation factors, relationship to service, and interaction with other SoPs — follows the standard template for these instruments. The update reflects new medical evidence but does not represent scope creep beyond the original purpose of determining service connection for specific medical conditions."},"complexity_factors":["Moderate cross-referencing: Links to two other Acts (VEA and MRCA) and incorporates definitions from Schedule 1","Conditional logic in section 10: Distinguishes between causation of new fractures and aggravation of pre-existing fractures","Nested definitions: 'Pathological fracture' defined by inclusion of sub-conditions (acute vascular shock, compartment syndrome, etc.) and exclusion of additional fractures","Dual application framework: Different rules apply depending on whether claim is under VEA or MRCA, and whether fracture arose before, during, or after service","7 defined terms in Schedule 1, including medical definitions requiring clinical knowledge (osteomalacia, osteonecrosis)","Interaction clause (section 11): Creates dynamic relationship with other Statements of Principles that 'apply as in force from time to time'"],"plain_english_summary":"This instrument updates the medical test used by the Repatriation Medical Authority to decide when pathological fractures (breaks in already diseased or weakened bone) are compensable for veterans and current/former defence members under the VEA and MRCA. \n\nIt sets the \"balance of probabilities\" criteria linking service to fractures (including contribution to death), replaces the 2015 statement, and guides decision-makers on entitlement to pensions, treatment and other supports."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the prior Statement of Principles concerning fracture No. 95 of 2015 (s4) and replaces it with updated definitions and criteria. It defines 'pathological fracture' (including death) (s7), sets the balance‑of‑probabilities causation test (s8), enumerates qualifying medical factors and clinical‑worsening rules (s9–10), and limits application to claims under s120B of the VEA or s339 of the MRCA (s5). The repeal in s4 indicates a substantive update to scope and criteria compared with the earlier SoP."},"complexity_factors":["Causation standard: 'balance of probabilities' applied to medical‑scientific evidence (s8).","Enumerated medical factors and conditions that may establish connection (s9(1)).","Clinical worsening and fracture non‑union rules (treatment timing, smoking and diabetes as specific contributors) add procedural complexity (s7(2) Note3; s9(3)–(4); s10(2)).","Detailed definitional material and medical terms sit in the Schedule 1 dictionary (Schedule 1).","Interaction and dependency on other Statements of Principles where factors overlap (s11).","Limited application to claims under specific statutory provisions (s5), requiring cross‑reference to entitlement law.","Repeal and replacement of an earlier SoP introduces transition issues for existing claims (s4).","Administrative determination power vested in the Repatriation Medical Authority (s3) creates agency‑level discretion over future updates."],"plain_english_summary":"This Statement of Principles tells the Repatriation Medical Authority how to decide, on the balance of probabilities, whether a pathological fracture (including death from it) is connected to a veteran’s or member’s service under the VEA or MRCA. It replaces the 2015 fracture SoP and starts 24 September 2024 (ss2–4,8). It requires at least one specified medical factor (for example neoplasm, osteoporosis, osteomyelitis, Paget disease, or factors causing fracture non‑union such as smoking or diabetes) linked to relevant service (s9–10)."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-pathological-fracture-balance-of-probabilities-no-65-of-2024","history":"/api/acts/statement-of-principles-concerning-pathological-fracture-balance-of-probabilities-no-65-of-2024/history","analysis":"/api/acts/statement-of-principles-concerning-pathological-fracture-balance-of-probabilities-no-65-of-2024/analysis","conflicts":"/api/acts/statement-of-principles-concerning-pathological-fracture-balance-of-probabilities-no-65-of-2024/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-pathological-fracture-balance-of-probabilities-no-65-of-2024/important-cases","documents":"/api/acts/statement-of-principles-concerning-pathological-fracture-balance-of-probabilities-no-65-of-2024/documents"}}