{"id":"F2021L00351","name":"Statement of Principles concerning posterior tibialis tendinopathy (Balance of Probabilities) (No. 46 of 2021)","slug":"statement-of-principles-concerning-posterior-tibialis-tendinopathy-balance-of-probabilities-no-46-of","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440801,"registerId":"F2021L00351-fast-fetch-1775956305483","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning posterior tibialis tendinopathy (Balance of Probabilities) (No. 46 of 2021)","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 TIBIALIS TENDINOPATHY (Balance of Probabilities)\n\n(No. 46 of 2021)\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 March 2021\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:
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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 posterior tibialis tendinopathy (Balance of Probabilities) (No. 46 of 2021).\n\n2 Commencement\n\n This instrument commences on 27 April 2021.\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 posterior tibialis tendinopathy and death from posterior tibialis tendinopathy.\n\nMeaning of posterior tibialis tendinopathy\n\n(2) For the purposes of this Statement of Principles, posterior tibialis tendinopathy means inflammation or degeneration of the posterior tibialis tendon that produces localised pain or tenderness or rupture of the posterior tibialis tendon.\n\nDeath from posterior tibialis tendinopathy\n\n(3) For the purposes of this Statement of Principles, posterior tibialis tendinopathy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's posterior tibialis tendinopathy.\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 posterior tibialis tendinopathy and death from posterior tibialis tendinopathy 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\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, posterior tibialis tendinopathy or death from posterior tibialis tendinopathy is connected with the circumstances of a person's relevant service:\n\n(1) running or jogging an average of at least 60 kilometres per week, for at least the four weeks before the clinical onset of posterior tibialis tendinopathy;\n\n(2) undertaking weight bearing exercise involving repeated activity of the ankle joint of the affected leg:\n\n(a) at a minimum intensity of five METs; and\n\n(b) for at least six hours per week; and\n\nfor at least the four weeks before the clinical onset of posterior tibialis tendinopathy;\n\nNote: MET is defined in the Schedule 1 - Dictionary.\n\n(3) increasing the frequency, duration or intensity of weight bearing activity involving the ankle joint of the affected leg:\n\n(a) by at least 100 percent; and\n\n(b) to a minimum intensity of five METs; and\n\n(c) for at least four hours per day; and\n\nwithin the seven days before the clinical onset of posterior tibialis tendinopathy;\n\nNote: MET is defined in the Schedule 1 - Dictionary.\n\n(4) having trauma or surgery involving the affected posterior tibialis tendon within the 30 days before the clinical onset of posterior tibialis tendinopathy;\n\n(5) having an infection of the affected posterior tibialis tendon at the time of the clinical onset of posterior tibialis tendinopathy;\n\n(6) having gout involving the affected posterior tibialis tendon at the time of the clinical onset of posterior tibialis tendinopathy;\n\n(7) having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical onset of posterior tibialis tendinopathy;\n\nNote: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary.\n\n(8) running or jogging an average of at least 60 kilometres per week, for at least the four weeks before the clinical worsening of posterior tibialis tendinopathy;\n\n(9) undertaking weight bearing exercise involving repeated activity of the ankle joint of the affected leg:\n\n(a) at a minimum intensity of five METs; and\n\n(b) for at least six hours per week; and\n\nfor at least the four weeks before the clinical worsening of posterior tibialis tendinopathy;\n\nNote: MET is defined in the Schedule 1 - Dictionary.\n\n(10) increasing the frequency, duration or intensity of weight bearing activity involving the ankle joint of the affected leg:\n\n(a) by at least 100 percent; and\n\n(b) to a minimum intensity of five METs; and\n\n(c) for at least four hours per day; and\n\nwithin the seven days before the clinical worsening of posterior tibialis tendinopathy;\n\nNote: MET is defined in the Schedule 1 - Dictionary.\n\n(11) having trauma or surgery involving the affected posterior tibialis tendon within the 30 days before the clinical worsening of posterior tibialis tendinopathy;\n\n(12) having an infection of the affected posterior tibialis tendon at the time of the clinical worsening of posterior tibialis tendinopathy;\n\n(13) having gout involving the affected posterior tibialis tendon at the time of the clinical worsening of posterior tibialis tendinopathy;\n\n(14) having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical worsening of posterior tibialis tendinopathy;\n\nNote: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary.\n\n(15) inability to obtain appropriate clinical management for posterior tibialis tendinopathy.\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, posterior tibialis tendinopathy where the person's posterior tibialis tendinopathy 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 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 posterior tibialis tendinopathy—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 specified list of autoimmune diseases means:\n\n(a) ankylosing spondylitis;\n\n(b) inflammatory bowel disease;\n\n(c) psoriatic arthritis;\n\n(d) reactive arthritis;\n\n(e) rheumatoid arthritis; or\n\n(f) undifferentiated spondyloarthritis.\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":4,"scope_assessment":{"changed":false,"description":"This instrument maintains its original narrow scope. It addresses a single, specific medical condition (posterior tibialis tendinopathy) and establishes the causal factors required to connect that condition to military service for compensation purposes. The structure follows the standard template for Repatriation Medical Authority Statements of Principles without expansion into broader policy areas."},"complexity_factors":["Multiple nested conditions within factors (e.g., factor 8(2) requires minimum intensity of 5 METs AND at least 6 hours per week AND at least 4 weeks duration)","Cross-references to external legislation (Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004)","Technical medical terminology requiring definition (MET - metabolic equivalent of task, posterior tibialis tendon anatomy)","Temporal precision requirements (specific time windows: 4 weeks, 7 days, 30 days before clinical onset/worsening)","Distinction between 'clinical onset' and 'clinical worsening' with partially overlapping but distinct factor sets","Defined term 'terminal event' includes a closed list of 5 specific causes of death for determining death from the condition","Recursive reference structure in section 10 allowing other Statements of Principles to be incorporated by reference","Specific percentage thresholds (100% increase in activity) requiring mathematical calculation"],"plain_english_summary":"This Statement of Principles sets the legal test for awarding compensation to Australian veterans and defence members for posterior tibialis tendinopathy. Claims must meet the balance‑of‑probabilities standard: a medical diagnosis, at least one listed causal or aggravating factor (e.g., specific repetitive or traumatic loads, infection/autoimmune conditions, or lack of timely treatment), and a connection of that factor to military service. If those elements aren’t satisfied, compensation is unlikely."},"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":5,"scope_assessment":{"changed":false,"description":"The instrument itself does not indicate any change to the underlying scope. It expressly limits its application to claims under section 120B of the VEA or section 339 of the MRCA and defines criteria for linking posterior tibialis tendinopathy (and death from it) to relevant service, specifying the exposures and medical contributors that qualify."},"complexity_factors":["Technical medical definition and inclusion of death via a terminal event (s.6(2)–(3); Schedule 1).","Multiple quantitative exposure thresholds (running km/week, METs, hours/week) and precise time windows for onset or worsening (s.8(1)–(3), s.8(8)–(10)).","Different causal pathways: criteria for condition arising in service versus material contribution/aggravation where condition pre‑existed (s.9(2)).","Cross‑reference to other Statements of Principles when factors overlap, requiring inter‑instrument application (s.10).","Evidentiary and verification burden on claimants to prove activity levels, dates of clinical onset/worsening, trauma/surgery, infection, gout or autoimmune disease (s.8; Schedule 1).","Administrative discretion and legal standard: instrument made under s.196B(3) of the VEA and applied on the balance of probabilities (s.3; s.7).","Measurement and implementation complexity from using METs as a threshold and translating reported activities into MET/hours or kilometres (Schedule 1 MET; s.8).","Narrow listed autoimmune diseases in the Schedule which limit recognised medical contributors (Schedule 1).","Application limited to specific claim routes and commencement date, so not universally applicable to all former members (s.2–s.4)."],"plain_english_summary":"This Statement of Principles sets the medical and activity rules the Repatriation Medical Authority uses to decide, on the balance of probabilities, whether posterior tibialis tendinopathy (including death from it) is connected to a veteran’s or defence member’s relevant service under the VEA or MRCA. It defines the clinical condition and lists measurable exposure thresholds (e.g. running kilometres, METs, hours of weight‑bearing activity), time windows for onset or worsening, and specified contributors (trauma, infection, gout, listed autoimmune diseases), which determine entitlement decisions and evidentiary needs."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-posterior-tibialis-tendinopathy-balance-of-probabilities-no-46-of","history":"/api/acts/statement-of-principles-concerning-posterior-tibialis-tendinopathy-balance-of-probabilities-no-46-of/history","analysis":"/api/acts/statement-of-principles-concerning-posterior-tibialis-tendinopathy-balance-of-probabilities-no-46-of/analysis","conflicts":"/api/acts/statement-of-principles-concerning-posterior-tibialis-tendinopathy-balance-of-probabilities-no-46-of/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-posterior-tibialis-tendinopathy-balance-of-probabilities-no-46-of/important-cases","documents":"/api/acts/statement-of-principles-concerning-posterior-tibialis-tendinopathy-balance-of-probabilities-no-46-of/documents"}}