{"id":"F2024L01341","name":"Statement of Principles concerning retrocalcaneal heel bursitis (Balance of Probabilities) (No. 89 of 2024)","slug":"statement-of-principles-concerning-retrocalcaneal-heel-bursitis-balance-of-probabilities-no-89-of-20","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442623,"registerId":"F2024L01341-fast-fetch-1775957589991","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning retrocalcaneal heel bursitis (Balance of Probabilities) (No. 89 of 2024)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nRETROCALCANEAL HEEL BURSITIS  (Balance of Probabilities)\n\n(No. 89 of 2024)\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 October 2024.\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\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\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning retrocalcaneal heel bursitis (Balance of Probabilities) (No. 89 of 2024).\n\n1.                Commencement\n\n\n              This instrument commences on 19 November 2024.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning Achilles tendinopathy and bursitis (Balance of Probabilities) (No. 97 of 2015) (Federal Register of Legislation No. F2015L01337) made under subsection 196B(3) of the VEA is repealed.\n\n1.                Application\n\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\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about retrocalcaneal heel bursitis and death from retrocalcaneal heel bursitis.\n\n\nMeaning of retrocalcaneal heel bursitis\n\n1.           For the purposes of this Statement of Principles, retrocalcaneal heel bursitis:\n  1.           means inflammation of the deep Achilles bursa located between the distal Achilles tendon and the calcaneus bone; and\n  2.           excludes posterior adventitial heel bursitis.\n\n\nDeath from retrocalcaneal heel bursitis\n\n1.           For the purposes of this Statement of Principles, retrocalcaneal heel bursitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's retrocalcaneal heel bursitis.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that retrocalcaneal heel bursitis and death from retrocalcaneal 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\n1.                Factors that must exist\n\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, retrocalcaneal heel bursitis or death from retrocalcaneal heel bursitis is connected with the circumstances of a person's relevant service:\n\n1.           Running or jogging an average of at least 60 kilometres per week for the 4 weeks before clinical onset or clinical worsening;\n2.           undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side for:\n  1.           a minimum intensity of 5 METS; and\n  2.           for at least 6 hours per week; and\n  3.           for at least the 4 weeks before clinical onset or clinical worsening;\n\n\nNote 1: Examples of weight bearing exercise involving repeated activity of the ankle joint at a minimum intensity of 5 METS include marching, playing basketball, football, volleyball, and track and field (especially those activities that involve jumping).\n\nNote 2: MET (metabolic equivalent) is a unit of measure of the level of physical capability of the cardiorespiratory system. For example, 1 MET = cardiorespiratory effort associated with a person sitting, 3-4 METs = cardiorespiratory effort associated with a person walking at average walking pace (5 km/h) or light gardening.\n\n1.           having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening:\n  1.           ankylosing spondylitis;\n  2.           Behcet syndrome;\n  3.           enteropathic spondyloarthropathy (arthritis associated with inflammatory bowel disease);\n  4.           gout;\n  5.           pseudogout (calcium pyrophosphate dihydrate) or crystal-induced arthropathy from the deposition of calcium hydroxyapatite or calcium oxalate;\n  6.            psoriatic arthropathy;\n  7.           reactive arthritis;\n  8.           rheumatoid arthritis; or\n  9.             undifferentiated spondyloarthropathy;\n2.           having a bacterial infection of the affected retrocalcaneal bursa at the time of clinical onset or clinical worsening;\n3.           inability to obtain appropriate clinical management for retrocalcaneal heel bursitis before clinical worsening.\n\n\n1.            Relationship to service\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  2.           The clinical worsening aspects of factors set out in section 9 apply only to material contribution to, or aggravation of, retrocalcaneal heel bursitis where the person's retrocalcaneal heel bursitis was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 9 applies in relation to a person; and\n2.           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\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                             MRCA means the Military Rehabilitation and Compensation Act 2004.\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 defined in the Schedule 1 - Dictionary.\n\n                             retrocalcaneal heel bursitis—see subsection 7(2).\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":"The legislation maintains its original narrow purpose: establishing medical criteria for a specific heel condition in veterans' compensation claims. The 2024 version represents a technical update (splitting retrocalcaneal heel bursitis from Achilles tendinopathy) rather than scope expansion. The defined coverage remains limited to the specific bursitis condition and its relationship to service."},"complexity_factors":["Short, single-purpose instrument (approximately 1,500 words)","Only 5 defined terms in the Dictionary (MRCA, relevant service, retrocalcaneal heel bursitis, terminal event, VEA)","Clear, numbered list of 6 factors in section 9 with minimal cross-referencing","Simple conditional structure: 'at least one of the following factors must exist'","Single exclusion clause (posterior adventitial heel bursitis excluded from definition)","One nested note explaining METs (metabolic equivalents) with practical examples","Straightforward repeal of single predecessor instrument","No exceptions to exceptions or deeply nested logical operators"],"plain_english_summary":"This instrument sets the medical criteria for awarding compensation to veterans and current/former defence members for retrocalcaneal heel bursitis. It requires a service connection on the balance of probabilities, identifying service-related risk factors (eg, intense running or high-impact ankle activities, certain arthritides, infection, or inadequate treatment of a pre-existing condition) as bases for causation or material worsening.\n\nIt replaces a 2015 rule that grouped this with Achilles tendinopathy and also covers death where the condition contributed."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"Yes. The instrument expressly repeals the 2015 Statement that covered Achilles tendinopathy and bursitis and substitutes a focused Statement for retrocalcaneal heel bursitis only (section 4 and section 7(2)). It narrows diagnostic coverage by excluding posterior adventitial heel bursitis (section 7(2)(2)) and therefore alters which claims qualify; applicability remains confined to specified VEA and MRCA claim types (section 5; Schedule 1)."},"complexity_factors":["Specific medical definition and an explicit exclusion of posterior adventitial heel bursitis (section 7(2)).","Legal causation standard is the balance of probabilities (section 8), not a higher scientific threshold.","Multiple possible qualifying factors with quantitative thresholds (running ≥60 km/week for 4 weeks; weight‑bearing ≥5 METs for ≥6 hours/week for 4 weeks) creating evidentiary demands (section 9(1)(a) and 9(1)(b)).","Use of METs and activity examples introduces technical measurement/elaboration requirements (note to section 9(1)(b)).","Clinical worsening vs first onset distinction and limitation of aggravation to pre‑existing conditions adds interpretive nuance (section 10(2)).","Requirement that any listed factor be related to the person’s relevant service ties medical facts to service records and eligibility rules (section 10(1); Schedule 1 definitions).","Interplay with other Statements of Principles means conditions referenced may invoke separate SOPs, adding cross‑reference complexity (section 11).","Instrument repeals an earlier, broader SOP, changing coverage and requiring transition for past claims (section 4).","Application is limited to claims under specified provisions of the VEA and the MRCA, so eligibility depends on claim type and service classification (section 5; Schedule 1).","Inclusion of death requires linking a terminal event to the bursitis, invoking Schedule 1’s definition of terminal event and proximate causation (section 7(3); Schedule 1)."],"plain_english_summary":"This instrument sets the medical criteria for linking retrocalcaneal heel bursitis (inflammation of the deep Achilles bursa) to a veteran’s relevant service and replaces a prior, broader Achilles tendinopathy and bursitis statement. \n\nIt requires, on the balance of probabilities, at least one service‑related factor — examples include specified running or repeated weight‑bearing at defined intensity/duration, certain systemic arthritic diseases, bursal infection, or lack of timely clinical management — to establish the connection (including death from the condition)."},"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-retrocalcaneal-heel-bursitis-balance-of-probabilities-no-89-of-20","history":"/api/acts/statement-of-principles-concerning-retrocalcaneal-heel-bursitis-balance-of-probabilities-no-89-of-20/history","analysis":"/api/acts/statement-of-principles-concerning-retrocalcaneal-heel-bursitis-balance-of-probabilities-no-89-of-20/analysis","conflicts":"/api/acts/statement-of-principles-concerning-retrocalcaneal-heel-bursitis-balance-of-probabilities-no-89-of-20/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-retrocalcaneal-heel-bursitis-balance-of-probabilities-no-89-of-20/important-cases","documents":"/api/acts/statement-of-principles-concerning-retrocalcaneal-heel-bursitis-balance-of-probabilities-no-89-of-20/documents"}}