{"id":"F2023L00472","name":"Statement of Principles concerning plantar fibromatosis (Reasonable Hypothesis) (No. 21 of 2023)","slug":"statement-of-principles-concerning-plantar-fibromatosis-reasonable-hypothesis-no-21-of-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441817,"registerId":"F2023L00472-fast-fetch-1775957016690","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning plantar fibromatosis (Reasonable Hypothesis) (No. 21 of 2023)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 22.10.0\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nPLANTAR FIBROMATOSIS (Reasonable Hypothesis)\n\n(No. 21 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 24 April 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 Application\n\n5 Definitions\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n7 Basis for determining the factors\n\n8 Factors that must exist\n\n9 Relationship to service\n\n10 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 fibromatosis (Reasonable Hypothesis) (No. 21 of 2023).\n\n2 Commencement\n\n This instrument commences on 23 May 2023.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 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\n5 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about plantar fibromatosis and death from plantar fibromatosis.\n\nMeaning of plantar fibromatosis\n\n(2) For the purposes of this Statement of Principles, plantar fibromatosis:\n\n(a) means a benign, progressive fibroproliferative disease of the plantar fascia and the digital fascia of the foot, which causes puckering and thickening of the plantar skin and nodule and cord formation in the fascia that may progress to contracture of the digits; and\n\n(b) excludes:\n\n(i) plantar fasciitis;\n\n(ii) plantar fascial tear;\n\n(iii) hyperplastic wound scarring; and\n\n(iv) soft tissue benign or malignant neoplasia.\n\nNote: plantar fibromatosis is also known as Ledderhose disease or morbus Ledderhose.\n\nDeath from plantar fibromatosis\n\n(3) For the purposes of this Statement of Principles, plantar fibromatosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's plantar fibromatosis.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n7 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 fibromatosis and death from plantar fibromatosis 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\n8 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 fibromatosis or death from plantar fibromatosis with the circumstances of a person's relevant service:\n\n(1) having alcohol use disorder at the time of the clinical onset of plantar fibromatosis;\n\n(2) having alcoholic liver cirrhosis at the time of the clinical onset of plantar fibromatosis;\n\n(3) having diabetes mellitus before the clinical onset of plantar fibromatosis;\n\n(4) having epilepsy at the time of the clinical onset of plantar fibromatosis;\n\n(5) taking phenobarbital or primidone regularly for the treatment of epilepsy:\n\n(a) for a continuous period of at least 2 years before the clinical onset of plantar fibromatosis; and\n\n(b) where this treatment has ceased, the clinical onset of plantar fibromatosis has occurred within the 1 year of cessation;\n\n(6) taking vemurafenib within the 2 years before the clinical onset of plantar fibromatosis;\n\n(7) having trauma to the affected foot within the 1 year before the clinical onset of plantar fibromatosis;\n\nNote: trauma is defined in the Schedule 1 –Dictionary.\n\n(8) having alcohol use disorder at the time of the clinical worsening of plantar fibromatosis;\n\n(9) having alcoholic liver cirrhosis at the time of the clinical worsening of plantar fibromatosis;\n\n(10) having diabetes mellitus before the clinical worsening of plantar fibromatosis;\n\n(11) having epilepsy at the time of the clinical worsening of plantar fibromatosis;\n\n(12) taking phenobarbital or primidone regularly for the treatment of epilepsy:\n\n(a) for a continuous period of at least 2 years before the clinical worsening of plantar fibromatosis; and\n\n(b) where this treatment has ceased, the clinical worsening of plantar fibromatosis has occurred within the 1 year of cessation;\n\n(13) taking vemurafenib within the 2 years before the clinical worsening of plantar fibromatosis;\n\n(14) having trauma to the affected foot within the 1 year before the clinical worsening of plantar fibromatosis;\n\nNote: trauma is defined in the Schedule 1 –Dictionary.\n\n(15) inability to obtain appropriate clinical management for plantar fibromatosis.\n\n9 Relationship to service\n\n(1) The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.\n\n(2) The factors set out in subsections 8(8) to 8(15) apply only to material contribution to, or aggravation of, plantar fibromatosis where the person's plantar fibromatosis was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n10 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 8 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 5\n\n1 Definitions\n\nIn this instrument:\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n plantar fibromatosis—see subsection 6(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 trauma means a significant injury, resulting in symptoms and signs lasting for at least seven days, or which is of sufficient severity to warrant medical attention, and includes laceration, sprain, crush injury, fracture, surgery, and thermal, chemical or electrical burns.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains its original narrow scope as a specific disease-based Statement of Principles under the veterans' compensation framework. It addresses only plantar fibromatosis and its relationship to service, consistent with the Repatriation Medical Authority's standard template for individual conditions."},"complexity_factors":["Moderate cross-referencing between sections (e.g., section 10 requires understanding of other Statements of Principles)","Temporal conditions attached to factors (e.g., 'within 1 year', 'for a continuous period of at least 2 years', 'before the clinical onset')","Distinction between 'clinical onset' and 'clinical worsening' with partially overlapping but distinct factor sets","Nested definitions requiring navigation to Schedule 1 (Dictionary)","Conditional logic in section 9(2) restricting application of worsening factors to pre-existing conditions","Exclusion clauses in the disease definition (subsection 6(2)(b)) that require medical knowledge to interpret"],"plain_english_summary":"This Statement of Principles guides whether plantar fibromatosis (Ledderhose disease) can be accepted as service-related for Australian veterans’ compensation. It sets the medical factors that, if present, create a “reasonable hypothesis” that the condition was caused or aggravated by ADF service.\n\nIt affects current and former ADF members claiming under veterans’ compensation laws and links service-relevant risks—such as alcohol misuse, diabetes, epilepsy or certain medications, and recent foot trauma—to either new onset or worsening of the disease."},"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"},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":false,"description":"The instrument establishes a standalone set of medical criteria for linking plantar fibromatosis (and related death) to relevant service for VEA/MRCA claims. The text does not indicate it widens or narrows an earlier scope; it defines the condition, lists qualifying factors, timing rules and how pre‑existing disease is treated (see ss6–10 and Schedule 1)."},"complexity_factors":["Narrow clinical focus but uses specialised medical terminology and diagnostic distinctions (see s6(2)).","Multiple discrete qualifying factors with precise time windows and cessation rules (see s8(5),(6),(12),(13)).","Different legal treatment where condition pre‑existed service (material contribution/aggravation only) adding evidentiary nuance (see s9(2)).","Cross‑references to other Statements of Principles where factors concern other injuries/diseases (see s10).","Defined evidentiary thresholds for trauma and terminal events in the Schedule, which affect causation findings (Schedule 1).","Limited administrative scope to claims under VEA or MRCA, tying medical criteria to entitlement frameworks (see s4)."],"plain_english_summary":"This Statement of Principles sets the medical criteria the Repatriation Medical Authority uses to decide when plantar fibromatosis (and death from it) can be reasonably linked to a veteran’s relevant service for claims under the VEA or MRCA (see ss3–4,6). It lists qualifying factors (for example: alcohol use disorder, alcoholic cirrhosis, diabetes, epilepsy and certain medicines, recent foot trauma, or inability to obtain appropriate care), with specific timing rules, and requires those factors to be related to the person’s relevant service (see s8–9)."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-plantar-fibromatosis-reasonable-hypothesis-no-21-of-2023","history":"/api/acts/statement-of-principles-concerning-plantar-fibromatosis-reasonable-hypothesis-no-21-of-2023/history","analysis":"/api/acts/statement-of-principles-concerning-plantar-fibromatosis-reasonable-hypothesis-no-21-of-2023/analysis","conflicts":"/api/acts/statement-of-principles-concerning-plantar-fibromatosis-reasonable-hypothesis-no-21-of-2023/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-plantar-fibromatosis-reasonable-hypothesis-no-21-of-2023/important-cases","documents":"/api/acts/statement-of-principles-concerning-plantar-fibromatosis-reasonable-hypothesis-no-21-of-2023/documents"}}