{"id":"F2021L00350","name":"Statement of Principles concerning posterior tibialis tendinopathy (Reasonable Hypothesis) (No. 45 of 2021)","slug":"statement-of-principles-concerning-posterior-tibialis-tendinopathy-reasonable-hypothesis-no-45-of-20","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440800,"registerId":"F2021L00350-fast-fetch-1775956305482","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 (Reasonable Hypothesis) (No. 45 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 (Reasonable Hypothesis)\n\n(No. 45 of 2021)\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 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 (Reasonable Hypothesis) (No. 45 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(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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that posterior tibialis tendinopathy and death from posterior tibialis tendinopathy 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 posterior tibialis tendinopathy or death from posterior tibialis tendinopathy 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 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 four 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 two 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 30 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 four 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 two 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(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 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) 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 specified list of autoimmune diseases means:\n\n(a) ankylosing spondylitis;\n\n(b) coeliac disease;\n\n(c) inflammatory bowel disease;\n\n(d) psoriatic arthritis;\n\n(e) reactive arthritis;\n\n(f) rheumatoid arthritis; or\n\n(g) 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 is a standard, discrete Statement of Principles instrument of the kind regularly made by the Repatriation Medical Authority. It addresses a single specific medical condition (posterior tibialis tendinopathy) and operates within the established statutory framework for military compensation. There is no indication of scope creep; the instrument follows the standard template and addresses only the condition specified in its title."},"complexity_factors":["Multiple parallel factor structures with subtle distinctions between 'clinical onset' (factors 1-7) and 'clinical worsening' (factors 8-14)","Technical medical measurement required: METs (metabolic equivalents of task) with specific thresholds (5 METs minimum)","Precise quantitative thresholds throughout: 30km/week, 4 hours/week, 100% increase, 7 days, 30 days, 4 weeks","Cross-referential structure: factor 15 (inability to obtain clinical management) applies only to worsening, but this is not immediately obvious without reading section 9(2)","Nested definitions in Schedule 1 including a closed list of 7 specific autoimmune diseases","Interaction with other Statements of Principles via section 10, creating potential for external factor incorporation","Dual statutory framework application (VEA and MRCA) with six different service types defined"],"plain_english_summary":"This instrument sets the criteria for when Australian defence members and veterans can plausibly link posterior tibialis tendinopathy to service for compensation purposes. It prescribes the specific circumstances that must exist to meet the “reasonable hypothesis” test and distinguishes onset versus worsening claims. Practically, it determines which ankle‑tendon claims succeed: if the listed service‑related factors aren’t met, entitlement for this condition is unlikely."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":false,"description":"The instrument itself establishes a standalone set of criteria for linking posterior tibialis tendinopathy to relevant service and applies to claims under section 120A of the VEA or section 338 of the MRCA (section 4). It does not state that it amends, replaces or narrows a prior Statement of Principles, nor does it include provisions that explicitly expand or contract scope beyond the criteria and definitions contained within this instrument."},"complexity_factors":["Technical medical thresholds and measurements (MET units and clinical onset/worsening time windows).","Multiple alternative and conditional factors (15 listed alternatives for onset or aggravation).","Cross-references to other Statements of Principles when factors relate to other injuries or diseases (section 10).","Requirement that any listed factor be related to the person's relevant service (section 9).","Dependence on defined terms in Schedule 1 (e.g., relevant service, specified autoimmune diseases, terminal event).","A broadly worded non-medical factor—'inability to obtain appropriate clinical management'—that may raise evidentiary and interpretation issues (section 8(15)).","Application limited to claims under specified statutory provisions (section 4), constraining scope of use."],"plain_english_summary":"This instrument sets the medical criteria the Repatriation Medical Authority uses to decide whether posterior tibialis tendinopathy (including death contributed to by it) can be linked to a veteran’s relevant service for claims under the VEA or MRCA. It lists specific clinical definitions, activity thresholds (running, weight‑bearing exercise measured in METs), timing windows, and other risk factors that, if present and related to service, raise a “reasonable hypothesis” connecting the condition to service. Decisions rely on these factors and the claimant’s evidentiary showing."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-posterior-tibialis-tendinopathy-reasonable-hypothesis-no-45-of-20","history":"/api/acts/statement-of-principles-concerning-posterior-tibialis-tendinopathy-reasonable-hypothesis-no-45-of-20/history","analysis":"/api/acts/statement-of-principles-concerning-posterior-tibialis-tendinopathy-reasonable-hypothesis-no-45-of-20/analysis","conflicts":"/api/acts/statement-of-principles-concerning-posterior-tibialis-tendinopathy-reasonable-hypothesis-no-45-of-20/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-posterior-tibialis-tendinopathy-reasonable-hypothesis-no-45-of-20/important-cases","documents":"/api/acts/statement-of-principles-concerning-posterior-tibialis-tendinopathy-reasonable-hypothesis-no-45-of-20/documents"}}