{"id":"F2023L01134","name":"Statement of Principles concerning plantar fasciitis (Reasonable Hypothesis) (No. 82 of 2023)","slug":"statement-of-principles-concerning-plantar-fasciitis-reasonable-hypothesis-no-82-of-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442044,"registerId":"F2023L01134-fast-fetch-1775957169513","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning plantar fasciitis (Reasonable Hypothesis) (No. 82 of 2023)","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\nPLANTAR FASCIITIS (Reasonable Hypothesis)\n\n(No. 82 of 2023)\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 25 August 2023.\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 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 plantar fasciitis (Reasonable Hypothesis) (No. 82 of 2023).\n\n2 Commencement\n\n This instrument commences on 26 September 2023.\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 plantar fasciitis No. 51 of 2015 (Federal Register of Legislation No. F2015L00257) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 plantar fasciitis and death from plantar fasciitis.\n\nMeaning of plantar fasciitis\n\n(2) For the purposes of this Statement of Principles, plantar fasciitis:\n\n(a) means a painful inflammatory or degenerative condition of the plantar fascia of the foot; and\n\n(b) excludes plantar fibromatosis.\n\nNote: Clinical manifestations typically include pain in the inferior heel that is worse with the first steps in the morning or after a period of inactivity. There may be tenderness of the inferior heel.\n\nDeath from plantar fasciitis\n\n(3) For the purposes of this Statement of Principles, plantar fasciitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's plantar fasciitis.\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 plantar fasciitis and death from plantar fasciitis 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 plantar fasciitis or death from plantar fasciitis with the circumstances of a person's relevant service:\n\n(1) having trauma to the plantar aspect of the affected foot within the seven days before the clinical onset or clinical worsening of plantar fasciitis;\n\n(2) having an infection involving the plantar fascia at the time of the clinical onset or clinical worsening of plantar fasciitis;\n\n(3) running or jogging an average of at least 30 kilometres per week for at least the 2 months before the clinical onset or clinical worsening of plantar fasciitis;\n\n(4) undertaking exercise that involves repetitive weight bearing on the affected foot for:\n\n(a) a minimum intensity of 5 METS; and\n\n(b) for at least 4 hours per week; and\n\nfor at least the 2 months before the clinical onset or clinical worsening of plantar fasciitis;\n\nNote: MET is defined in the Schedule 1 - Dictionary.\n\nNote: Exercise that involves repetitive weight bearing on the affected foot includes marching, jumping, soccer, tennis, or dancing.\n\n(5) increasing the frequency, duration or intensity of weight bearing activity involving the affected foot:\n\n(a) by at least 100 percent; and\n\n(b) to a minimum intensity of 5 METs; and\n\n(c) for at least 2 hours per day;\n\nand within the seven days before the clinical onset or clinical worsening of plantar fasciitis;\n\nNote: MET is defined in the Schedule 1 – Dictionary\n\n \n\n(6) undergoing prolonged weight bearing on the affected foot while on a hard surface for at least five hours per day, on more days than not, for the 6 months before the clinical onset or clinical worsening of plantar fasciitis;\n\n(7) being overweight or obese at the time of the clinical onset or clinical worsening of plantar fasciitis;\n\nNote: being overweight or obese is defined in the Schedule 1 – Dictionary.\n\n(8) having a systemic arthritic disease at the time of the clinical onset or clinical worsening of plantar fasciitis;\n\nNote: systemic arthritic disease is defined in the Schedule 1 – Dictionary.\n\n(9) having an acquired biomechanical abnormality involving the affected foot before the clinical onset or clinical worsening of plantar fasciitis;\n\nNote: biomechanical abnormality is defined in the Schedule 1 – Dictionary.\n\n(10) wearing footwear with inadequate cushioning during weight bearing exercise which involves the affected foot within the seven days before the clinical onset or clinical worsening of plantar fasciitis;\n\n(11) inability to obtain appropriate clinical management for plantar fasciitis before the clinical worsening of plantar fasciitis.\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 aspect of factors apply only to material contribution to, or aggravation of, plantar fasciitis where the person's plantar fasciitis 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 being overweight or obese means having a Body Mass Index (BMI) of 25 or greater.\n\nNote: BMI is defined in the Schedule 1 – Dictionary.\n\n biomechanical abnormality means injury or disease that has resulted in overpronation or underpronation, or decreased ankle or forefoot flexibility.\n\n BMI means W/H2 where:\n\n W is the person's weight in kilograms; and\n\n H is the person's height in metres.\n\n clinical onset means the point backwards in time from the first date of medical diagnosis, to the date at which the symptoms of plantar fasciitis were persistently present, as assessed by a registered medical practitioner.\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 other crystal-induced arthropathy means arthropathy resulting from the deposition of calcium hydroxyapatite or calcium oxalate.\n\n plantar fasciitis—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 systemic arthritic disease means:\n\n(a) ankylosing spondylitis;\n\n(b) enteropathic spondyloarthropathy (arthritis associated with inflammatory bowel disease);\n\n(c) psoriatic arthropathy;\n\n(d) reactive arthritis;\n\n(e) undifferentiated spondyloarthropathy;\n\n(f) gout;\n\n(g) pseudogout (calcium pyrophosphate dehydrate);\n\n(h) other crystal-induced arthropathy.\n\nNote: other crystal-induced arthropathy is 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":true,"description":"This instrument expressly repeals the 2015 Statement (s4) and replaces it with updated definitions and qualifying factors (s7–9; Schedule 1). It continues to apply to claims under the VEA and MRCA (s5) but alters the concrete medical thresholds and defined terms claimants and decision‑makers must apply (see s9 and Schedule 1)."},"complexity_factors":["Many discrete, quantitative thresholds to prove a connection (e.g. running ≥30 km/week for ≥2 months; exercise intensity ≥5 METs; increase by ≥100% to ≥5 METs for ≥2 hours/day) (s9(3)–(5)).","Multiple time windows and onset concepts (clinical onset/clinical worsening, 7‑day and 2‑month and 6‑month windows) create evidentiary timing burdens (s9; Schedule 1 definition of clinical onset).","Several defined medical terms require clinical assessment (BMI formula; biomechanical abnormality; systemic arthritic disease), shifting evidentiary weight to treating practitioners (Schedule 1).","Interaction with other Statements of Principles means relevant factors may be governed by separate instruments, adding cross‑reference complexity (s11).","Application limited to specified claim types under VEA/MRCA, so procedural scope ties to administrative entitlement regimes (s5).","Some criteria contain subjective elements (e.g. “inadequate cushioning”, “inability to obtain appropriate clinical management”, “more days than not”), increasing decision‑maker discretion (s9(10),(11); s9(6)).","Burden on claimants to produce activity, footwear, medical history and BMI evidence; government liability depends on RMA causation findings (ss3,8,9)."],"plain_english_summary":"This instrument repeals the 2015 Statement and sets updated medical criteria the Repatriation Medical Authority uses to link plantar fasciitis to relevant service (ss 3–5, 8). It lists clinical definitions and specific qualifying factors — trauma, infection, defined running/exercise thresholds, prolonged weight‑bearing, BMI ≥25, systemic arthritis, biomechanical abnormalities, footwear or treatment access — that, if met, raise a reasonable hypothesis for VEA/MRCA claims and affect entitlement decisions and related government liabilities."},"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. The scope remains tightly focused on establishing medical criteria for linking plantar fasciitis to military service, consistent with the original legislative intent of the Veterans' Entitlements Act framework. The 2023 version updates the 2015 predecessor but does not expand beyond the established purpose of providing compensation pathways for service-related heel conditions."},"complexity_factors":["11 distinct causal factors with varying temporal requirements (ranging from 7 days to 6 months lookback periods)","Multiple defined terms in Schedule 1 (approximately 12 definitions including nested definitions like 'other crystal-induced arthropathy' being used within 'systemic arthritic disease')","Technical medical measurements required (METs - metabolic equivalents, BMI calculations)","Cross-referencing between this instrument and other Statements of Principles via section 11","Dual application framework (VEA and MRCA with different service categories)","Distinction between 'clinical onset' and 'clinical worsening' with different rules for each","Specific quantitative thresholds (30km/week, 5 METs, 4 hours/week, 100% increase, 5 hours/day)"],"plain_english_summary":"This instrument updates the medical rules governing when plantar fasciitis is accepted as service-related for veterans and ADF members under the VEA and MRCA, replacing the 2015 guidance and specifying 11 clinical and activity-related factors the Repatriation Medical Authority may use.\n\nIt matters because meeting any listed factor can create a \"reasonable hypothesis\" linking the condition to service— a lower standard than proving causation on the balance of probabilities, affecting claim outcomes."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-plantar-fasciitis-reasonable-hypothesis-no-82-of-2023","history":"/api/acts/statement-of-principles-concerning-plantar-fasciitis-reasonable-hypothesis-no-82-of-2023/history","analysis":"/api/acts/statement-of-principles-concerning-plantar-fasciitis-reasonable-hypothesis-no-82-of-2023/analysis","conflicts":"/api/acts/statement-of-principles-concerning-plantar-fasciitis-reasonable-hypothesis-no-82-of-2023/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-plantar-fasciitis-reasonable-hypothesis-no-82-of-2023/important-cases","documents":"/api/acts/statement-of-principles-concerning-plantar-fasciitis-reasonable-hypothesis-no-82-of-2023/documents"}}