{"id":"F2017L01058","name":"Statement of Principles concerning popliteal entrapment syndrome (Balance of Probabilities) (No. 55 of 2017)","slug":"statement-of-principles-concerning-popliteal-entrapment-syndrome-balance-of-probabilities-no-55-of-2","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439303,"registerId":"F2017L01058-fast-fetch-1775955381182","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning popliteal entrapment syndrome (Balance of Probabilities) (No. 55 of 2017)","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\nPOPLITEAL ENTRAPMENT SYNDROME (Balance of Probabilities)\n\n(No. 55 of 2017)\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 18 August 2017\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 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 popliteal entrapment syndrome (Balance of Probabilities) (No. 55 of 2017).\n\n2 Commencement\n\n This instrument commences on 18 September 2017.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 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\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 popliteal entrapment syndrome and death from popliteal entrapment syndrome.\n\nMeaning of popliteal entrapment syndrome\n\n(2) For the purposes of this Statement of Principles, popliteal entrapment syndrome means an acquired or congenital, partial or complete occlusion of the popliteal artery in the popliteal fossa, occurring during plantar flexion, in the presence of:\n\n(a) symptoms of intermittent lower limb claudication, exercise-induced leg pain, paraesthesia, or lower limb ischaemia, in the absence of other identifiable vascular risk factors that can account for those symptoms; and\n\n(b) appropriate clinical imaging studies that confirm partial or complete occlusion.\n\nNote 1: Popliteal entrapment syndrome may cause intimal damage, thrombosis, distal embolism, post-stenotic dilation or aneurysm of the popliteal artery. Popliteal artery entrapment may be accompanied by compression of the popliteal vein or tibial nerve. Aberrant anatomy of a musculotendinous structure in the popliteal fossa may be present.\n\nNote 2: Appropriate clinical imaging studies include Doppler ultrasonography, static or dynamic magnetic resonance imaging/magnetic resonance angiography, computed tomography angiography, conventional catheter-based angiography with provocation, and intravascular ultrasound.\n\nDeath from popliteal entrapment syndrome\n\n(3) For the purposes of this Statement of Principles, popliteal entrapment syndrome, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's popliteal entrapment syndrome.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n7 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 popliteal entrapment syndrome and death from popliteal entrapment syndrome can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\nNote: relevant service is defined in the Schedule 1 – Dictionary.\n\n8 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, popliteal entrapment syndrome or death from popliteal entrapment syndrome is connected 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 the 12 months before the clinical onset of popliteal entrapment syndrome;\n\n(2) undertaking vigorous physical activity involving repeated active plantar flexion of the foot of the affected leg, or repetitive sudden and forceful contraction of the calf of the affected leg, at a minimum intensity of six METs, for an average of at least 20 hours per week for a continuous period of at least the 12 months before the clinical onset of popliteal entrapment syndrome;\n\nNote 1: Vigorous physical activity may include driving heavy vehicles, martial arts, physical training, and sports such as rugby, soccer, basketball, rowing or cycling. Patients typically have hypertrophy of the plantar flexor muscles, including the gastrocnemius, soleus and plantaris muscles.\n\nNote 2: MET is defined in the Schedule 1 - Dictionary. \n\n(3) having trauma to the affected limb, involving the popliteal fossa and displacing the popliteal artery, within the five years before the clinical onset of popliteal entrapment syndrome;\n\n(4) having a disease involving the popliteal fossa and displacing the popliteal artery, at the time of the clinical onset of popliteal entrapment syndrome;\n\nNote: disease involving the popliteal fossa is defined in the Schedule 1 - Dictionary.\n\n(5) running or jogging an average of at least 15 kilometres per week for the six months before the clinical worsening of popliteal entrapment syndrome;\n\n(6) undertaking vigorous physical activity involving repeated active plantar flexion of the foot of the affected leg, or repetitive sudden and forceful contraction of the calf of the affected leg, at a minimum intensity of six METs, for an average of at least 20 hours per week for a continuous period of at least the six months before the clinical worsening of popliteal entrapment syndrome;\n\nNote 1: Vigorous physical activity may include driving heavy vehicles, martial arts, physical training, and sports such as rugby, soccer, basketball, rowing or cycling. Patients typically have hypertrophy of the plantar flexor muscles, including the gastrocnemius, soleus and plantaris muscles.\n\nNote 2: MET is defined in the Schedule 1 - Dictionary. \n\n(7) having trauma to the affected limb, involving the popliteal fossa and displacing the popliteal artery, within the five years before the clinical worsening of popliteal entrapment syndrome;\n\n(8) having a disease involving the popliteal fossa and displacing the popliteal artery, at the time of the clinical worsening of popliteal entrapment syndrome;\n\nNote: disease involving the popliteal fossa is defined in the Schedule 1 - Dictionary.\n\n(9) inability to obtain appropriate clinical management for popliteal entrapment syndrome.\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(5) to 8(9) apply only to material contribution to, or aggravation of, popliteal entrapment syndrome where the person's popliteal entrapment syndrome 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(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 5\n\n1 Definitions\n\nIn this instrument:\n\n disease involving the popliteal fossa means any pathological condition causing anatomical distortion of the popliteal fossa.\n\nNote: Examples of a disease involving the popliteal fossa include a primary or secondary neoplasm within the knee joint or the long bones of the leg, or a popliteal (Baker's) cyst.\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, 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 popliteal entrapment syndrome—see subsection 6(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\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a discrete, single-condition Statement of Principles made under the Veterans' Entitlements Act. It addresses one specific medical condition (popliteal entrapment syndrome) and follows the standard template for such instruments. There is no evidence of scope creep; it maintains the traditional structure of: definition of condition, factors for onset, factors for worsening, and relationship to service requirements."},"complexity_factors":["9 distinct factors with specific quantitative thresholds (30km/week, 15km/week, 20 hours/week, 6 METs, 12 months, 6 months, 5 years)","Cross-references to two separate Acts (VEA and MRCA) and requires understanding of 'relevant service' definition","Technical medical terminology requiring definitions (popliteal fossa, plantar flexion, METs, intimal damage, claudication, paraesthesia)","Bifurcated structure distinguishing between 'clinical onset' (factors 1-4) and 'clinical worsening' (factors 5-9)","Section 10 creates a recursive reference system linking to other Statements of Principles","Specific anatomical and physiological concepts (hypertrophy of plantar flexor muscles, gastrocnemius, soleus, plantaris)","Note hierarchy with some notes providing examples, others providing definitions, and others cross-referencing the Dictionary"],"plain_english_summary":"This instrument sets when popliteal entrapment syndrome can be accepted as service-related for veterans and current/former defence members claiming under the VEA or MRCA. A claim succeeds if, on the balance of probabilities, at least one of nine specified service‑related factors (training, trauma, disease, treatment access, with set distances/intensities/timeframes) links the condition to relevant service.\n\nIt matters because it defines precise thresholds that determine taxpayer-funded compensation."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"The instrument expressly limits its scope to popliteal entrapment syndrome and death from it for claims under the VEA and MRCA, and sets the medical/exposure criteria the Authority will apply (s4, s6). It does not on its face expand coverage beyond that defined scope."},"complexity_factors":["Technical diagnostic requirement: imaging-confirmed partial or complete occlusion of the popliteal artery is required (s6(2)(b)), creating a need for specific medical evidence.","Quantitative exposure thresholds: running kilometres, hours per week, and MET intensity minima create rigid numeric tests (s8(1),(2),(5),(6); Schedule 1 MET definition).","Temporal windows and tiers: different timeframes for onset versus worsening (12 months, 6 months, five-year trauma window) add sequencing complexity (s8, s9(2)).","Causal linkage to service: factors must be related to the person's relevant service as defined in the instrument, requiring factual linking of service activities to exposures (s9; Schedule 1 relevant service).","Interaction with other Statements of Principles: cross-application when a factor refers to another determined condition requires reading multiple instruments (s10).","Ambiguous/qualitative elements: terms like 'inability to obtain appropriate clinical management' and 'vigorous physical activity' (noted examples) leave scope for factual and clinical judgment (s8(9); s8 notes).","Administrative application: instrument applies to claims under specified statutory provisions, meaning decision-makers (the Authority and claims administrators) and claimants must apply these rules in the benefits process (s3, s4, s7)."],"plain_english_summary":"This instrument sets the medical and exposure rules the Repatriation Medical Authority will use to decide whether popliteal entrapment syndrome (and death from it) is connected to a person's service for VEA/MRCA claims. It requires imaging-confirmed arterial occlusion plus at least one specified exposure (running/kilometre thresholds, sustained vigorous plantar flexion measured in METs, trauma, local disease, or inability to obtain appropriate management) within defined timeframes, assessed on the balance of probabilities."},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-popliteal-entrapment-syndrome-balance-of-probabilities-no-55-of-2","history":"/api/acts/statement-of-principles-concerning-popliteal-entrapment-syndrome-balance-of-probabilities-no-55-of-2/history","analysis":"/api/acts/statement-of-principles-concerning-popliteal-entrapment-syndrome-balance-of-probabilities-no-55-of-2/analysis","conflicts":"/api/acts/statement-of-principles-concerning-popliteal-entrapment-syndrome-balance-of-probabilities-no-55-of-2/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-popliteal-entrapment-syndrome-balance-of-probabilities-no-55-of-2/important-cases","documents":"/api/acts/statement-of-principles-concerning-popliteal-entrapment-syndrome-balance-of-probabilities-no-55-of-2/documents"}}