{"id":"F2024L01043","name":"Statement of Principles concerning pathological fracture (Reasonable Hypothesis) (No. 64 of 2024)","slug":"statement-of-principles-concerning-pathological-fracture-reasonable-hypothesis-no-64-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442531,"registerId":"F2024L01043-fast-fetch-1775957509821","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning pathological fracture (Reasonable Hypothesis) (No. 64 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 (Reasonable Hypothesis)\n\n(No. 64 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 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 (Reasonable Hypothesis) (No. 64 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning fracture No. 94 of 2015 (Federal Register of Legislation No. F2015L01340) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that pathological fracture and death from pathological fracture 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 pathological fracture or death from pathological fracture 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) having osteoporosis 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(6) having vitamin D deficiency, with a serum 25(OH)D level of less than 50 nanomoles per litre 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(7) having a Body Mass Index (BMI) of 40 or greater at the time of the fracture non-union;\n\nNote 1: BMI is defined in the Schedule 1 - Dictionary.\n\nNote 2: Fracture non-union is considered to be a clinical worsening of the pathological fracture.\n\n(8) 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(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 BMI means W/H2 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 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) 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 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":6,"scope_assessment":{"changed":true,"description":"Yes. The instrument expressly repeals the earlier Statement of Principles concerning fracture No. 94 of 2015 (section 4) and defines its subject narrowly as 'pathological fracture' and death from pathological fracture (section 7). It replaces a broader fracture instrument with a framework that: (a) lists specific qualifying medical conditions and measurable risk factors as sufficient to raise a 'reasonable hypothesis' (section 9); (b) limits clinical‑worsening contribution to non‑union and related items and to fractures that pre‑dated or did not arise out of service (section 10(2)); and (c) sets defined numerical thresholds (vitamin D, BMI, smoking) and applicability to statutory claims under the VEA and MRCA (sections 5, 9, Schedule 1). These changes narrow and clarify the causal criteria used in entitlement assessments compared with the prior instrument referenced for repeal."},"complexity_factors":["Technical medical definitions and conditions (osteomalacia, osteonecrosis, Paget disease, etc.) requiring clinical interpretation (see section 7(2) and Schedule 1 definitions).","Mixed legal-medical threshold: 'reasonable hypothesis' triggered by at least one listed factor rather than probabilistic causation (section 9).","Conditional clinical‑worsening rules that apply only where fracture preceded or did not arise out of service (section 10(2)).","Interactions with other Statements of Principles: cross-application where factors refer to conditions covered by other SoPs (section 11).","Specific numerical diagnostic thresholds that require measurement and documentation (vitamin D <50 nmol/L, BMI formula and cutoff, smoking equivalence) (section 9 and Schedule 1).","Application limited to statutory claim pathways and defined types of 'relevant service' under VEA and MRCA (section 5 and Schedule 1).","Replaces a prior Statement of Principles (repeal in section 4), requiring administrators to map legacy cases to the new criteria."],"plain_english_summary":"**What this instrument does:** Establishes the medical criteria the Repatriation Medical Authority will use to decide whether a pathological fracture (or death from it) can be linked to a person’s military service. It applies to claims under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act. \n\n**Who it affects and why it matters:** Veterans and current/former members whose bones break from minimal trauma. The instrument lists specific diagnoses and measurable risk factors (for example osteoporosis, vitamin D <50 nmol/L, BMI≥40, smoking ≥5 cigarettes/day, fracture non‑union, or lack of appropriate care) — presence of at least one can raise a “reasonable hypothesis” that service contributed, guiding 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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the standard scope of Repatriation Medical Authority Statements of Principles. It replaces the 2015 fracture SoP with updated medical criteria but does not expand beyond the traditional purpose of establishing medical hypotheses for veteran compensation claims. The structure follows the standard template (factors, relationship to service, dictionary) used consistently across the SoP regime."},"complexity_factors":["Moderate cross-referencing: Section 11 requires reading alongside other Statements of Principles for diseases like cancer, diabetes, and osteoporosis","Conditional logic in section 10(2): Distinguishes between fractures arising during service versus pre-existing conditions aggravated by service","8 distinct factors with multiple sub-factors (section 9), some with nested notes and definitions","7 defined terms in Schedule 1, including mathematical formula for BMI and specific medical definitions (osteomalacia, osteonecrosis)","Multiple notes clarifying clinical worsening concepts, particularly around 'fracture non-union' being treated as worsening rather than new injury","Dual legislative framework application (VEA and MRCA) requiring understanding of different service types (operational, peacekeeping, hazardous, warlike, non-warlike)"],"plain_english_summary":"This rule replaces the 2015 test for pathological fractures, defining fractures caused by weakened bone (e.g., osteoporosis, cancer, infection) and recognizing related complications. It sets a medical gateway—requiring one of eight specified factors, linked to service and sometimes assessed under other disease rules—for veterans to qualify for compensation.\n\nIt affects veterans, peacekeepers and current/former defence members under the VEA and MRCA and determines whether fragile-bone injuries are compensable."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-pathological-fracture-reasonable-hypothesis-no-64-of-2024","history":"/api/acts/statement-of-principles-concerning-pathological-fracture-reasonable-hypothesis-no-64-of-2024/history","analysis":"/api/acts/statement-of-principles-concerning-pathological-fracture-reasonable-hypothesis-no-64-of-2024/analysis","conflicts":"/api/acts/statement-of-principles-concerning-pathological-fracture-reasonable-hypothesis-no-64-of-2024/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-pathological-fracture-reasonable-hypothesis-no-64-of-2024/important-cases","documents":"/api/acts/statement-of-principles-concerning-pathological-fracture-reasonable-hypothesis-no-64-of-2024/documents"}}