{"id":"F2019L00630","name":"Statement of Principles concerning posterior adventitial heel bursitis (Balance of Probabilities) (No. 48 of 2019)","slug":"statement-of-principles-concerning-posterior-adventitial-heel-bursitis-balance-of-probabilities-no-4","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440048,"registerId":"F2019L00630-fast-fetch-1775955832792","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning posterior adventitial heel bursitis (Balance of Probabilities) (No. 48 of 2019)","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\nPOSTERIOR ADVENTITIAL HEEL BURSITIS (Balance of Probabilities)\n\n(No. 48 of 2019)\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 26 April 2019\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 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 posterior adventitial heel bursitis (Balance of Probabilities) (No. 48 of 2019).\n\n2 Commencement\n\n This instrument commences on 27 May 2019.\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 heel bursitis No. 78 of 2010 (Federal Register of Legislation No. F2010L02317) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 posterior adventitial heel bursitis and death from posterior adventitial heel bursitis.\n\nMeaning of posterior adventitial heel bursitis\n\n(2) For the purposes of this Statement of Principles, posterior adventitial heel bursitis:\n\n(a) means inflammation of the superficial retro-Achilles bursa located between the skin and the distal Achilles tendon; and\n\n(b) is characterised by a painful and tender swelling of the posterior aspect of the heel; and\n\n(c) excludes retrocalcaneal bursitis and plantar calcaneal bursitis.\n\nNote: plantar calcaneal bursitis is defined in the Schedule 1 – Dictionary.\n\nDeath from posterior adventitial heel bursitis\n\n(3) For the purposes of this Statement of Principles, posterior adventitial heel bursitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's posterior adventitial heel bursitis.\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 posterior adventitial heel bursitis and death from posterior adventitial heel bursitis 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, posterior adventitial heel bursitis or death from posterior adventitial heel bursitis is connected with the circumstances of a person's relevant service:\n\n(1) wearing footwear that causes friction or pressure on the posterior aspect of the heel of the affected foot, at the time of the clinical onset of posterior adventitial heel bursitis;\n\n(2) having a Haglund deformity at the time of the clinical onset of posterior adventitial heel bursitis;\n\nNote: Haglund deformity is defined in the Schedule 1 - Dictionary. \n\n(3) wearing footwear that causes friction or pressure on the posterior aspect of the heel of the affected foot, at the time of the clinical worsening of posterior adventitial heel bursitis;\n\n(4) having a Haglund deformity at the time of the clinical worsening of posterior adventitial heel bursitis;\n\nNote: Haglund deformity is defined in the Schedule 1 - Dictionary. \n\n(5) inability to obtain appropriate clinical management for posterior adventitial heel bursitis.\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 factors set out in subsections 9(3) to 9(5) apply only to material contribution to, or aggravation of, posterior adventitial heel bursitis where the person's posterior adventitial heel bursitis 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 Haglund deformity means an abnormality of the posterosuperior part of the calcaneus, where there is a bony enlargement at the attachment of the Achilles tendon.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n plantar calcaneal bursitis means inflammation of the adventitial bursa located on the inferior aspect of the calcaneus near the insertion of the plantar fascia, characterised by heel pain at the plantar surface of the heel, mild warmth and swelling.\n\n posterior adventitial heel bursitis—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":{"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the original scope of Repatriation Medical Authority Statements of Principles. It replaces a 2010 instrument on the same general topic (heel bursitis) but narrows the focus to the specific posterior adventitial subtype rather than expanding into new areas. The scope remains tightly confined to determining service connection for this single medical condition under established veterans' compensation frameworks."},"complexity_factors":["Single medical condition with narrow scope (one specific bursitis type)","Only 7 defined terms in the Dictionary","Straightforward structure: 11 sections plus short definitions schedule","Simple conditional logic: 5 alternative factors, claimant needs only one","Limited cross-referencing (only to other Statements of Principles in section 11 and standard VEA/MRCA definitions)","No nested exceptions or complex temporal calculations beyond 'at time of clinical onset/worsening'","Clear exclusion of related conditions (retrocalcaneal and plantar calcaneal bursitis) to prevent overlap"],"plain_english_summary":"This instrument replaces the 2010 policy and sets the legal test for linking posterior adventitial heel bursitis to service, using the balance‑of‑probabilities standard. It affects veterans under the Veterans’ Entitlements Act and current/former defence members under the MRCA. Claims must show a service connection — commonly ill‑fitting military footwear, a Haglund deformity at onset/worsening, or inability to obtain treatment — with tighter rules where the condition pre‑existed service."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument repeals the earlier Statement of Principles No. 78 of 2010 (section 4) and replaces it with updated definitions, specified factors for establishing connection to service (section 9), timing rules for onset or worsening (section 10), and definitions in Schedule 1. It therefore updates the acceptance criteria and how posterior adventitial heel bursitis and related deaths are assessed for claims under section 120B of the VEA and section 339 of the MRCA."},"complexity_factors":["Medical specificity: the instrument defines the condition anatomically and by symptoms (subsection 7(2)), requiring medical evidence.","Enumerated causal/associative factors: the list of required factors (section 9) imposes discrete evidentiary points (footwear friction, Haglund deformity, lack of appropriate clinical management).","Timing distinctions: different rules apply depending on whether the condition arose, worsened, or pre‑existed service (section 10 and subsections 9(3)–9(5)), adding temporal evidentiary complexity.","Legal standard: reliance on the balance of probabilities and the RMA's view of available medical‑scientific evidence (section 8) frames the adjudicative threshold.","Cross‑instrument interaction: factors that overlap with other Statements of Principles are applied according to those other instruments (section 11), requiring cross‑reference.","Defined terms: multiple key terms are defined in Schedule 1 (Haglund deformity, terminal event, relevant service), so interpretation depends on those definitions.","Ambiguous evidentiary item: 'inability to obtain appropriate clinical management' (subsection 9(5)) may be factually and administratively difficult to prove.","Death linkage: includes death contributed to by the condition and lists examples of terminal events (subsection 7(3) and Schedule 1), which broadens compensable outcomes."],"plain_english_summary":"This Statement of Principles defines how posterior adventitial heel bursitis (inflammation of the superficial retro‑Achilles bursa) is judged to be connected to a veteran's or serving member's relevant service for claims under the Veterans' Entitlements Act or the MRCA. It replaces the earlier 2010 statement and commenced 27 May 2019. It specifies the medical characterisation of the condition and the service‑related circumstances (for example, posterior heel friction from footwear, a Haglund deformity, or inability to obtain appropriate clinical care) that must exist for acceptance of a claim."},"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-posterior-adventitial-heel-bursitis-balance-of-probabilities-no-4","history":"/api/acts/statement-of-principles-concerning-posterior-adventitial-heel-bursitis-balance-of-probabilities-no-4/history","analysis":"/api/acts/statement-of-principles-concerning-posterior-adventitial-heel-bursitis-balance-of-probabilities-no-4/analysis","conflicts":"/api/acts/statement-of-principles-concerning-posterior-adventitial-heel-bursitis-balance-of-probabilities-no-4/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-posterior-adventitial-heel-bursitis-balance-of-probabilities-no-4/important-cases","documents":"/api/acts/statement-of-principles-concerning-posterior-adventitial-heel-bursitis-balance-of-probabilities-no-4/documents"}}