{"id":"F2024L01339","name":"Statement of Principles concerning retrocalcaneal heel bursitis (Reasonable Hypothesis) (No. 88 of 2024)","slug":"statement-of-principles-concerning-retrocalcaneal-heel-bursitis-reasonable-hypothesis-no-88-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442622,"registerId":"F2024L01339-fast-fetch-1775957589981","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 (Reasonable Hypothesis) (No. 88 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  (Reasonable Hypothesis)\n\n(No. 88 of 2024)\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                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   \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 (Reasonable Hypothesis) (No. 88 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(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning Achilles tendinopathy and bursitis (Reasonable Hypothesis) (No. 96 of 2015) (Federal Register of Legislation No. F2015L01336) made under subsection 196B(2) of the VEA is repealed.\n\n1.                Application\n\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\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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that retrocalcaneal heel bursitis and death from retrocalcaneal heel bursitis 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\n1.                Factors that must exist\n\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 retrocalcaneal heel bursitis or death from retrocalcaneal heel bursitis with the circumstances of a person's relevant service:\n\n1.           Running or jogging an average of at least 30 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 4 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 chronic renal failure within the 10 years before clinical onset or clinical worsening as indicated by:\n  1.           a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or\n  2.           undergoing chronic dialysis for renal failure;\n3.           having a bacterial infection of the affected retrocalcaneal bursa at the time of clinical onset or clinical worsening;\n4.           wearing footwear that causes excessive pressure on the posterior aspect of the heel of the affected foot, at the time of clinical onset or clinical worsening;\n5.           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(2) 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)          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 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":{"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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":true,"description":"The legislation represents a narrowing and refinement of scope compared to the repealed 2015 instrument. Where the previous Statement of Principles covered both Achilles tendinopathy AND bursitis together, this 2024 instrument creates a standalone, focused regime specifically for retrocalcaneal heel bursitis. This allows for more precise medical factors tailored to bursitis (such as footwear pressure and bacterial infection) rather than applying tendon-focused criteria to a bursa condition. The scope has shifted from a broader musculoskeletal category to a specific anatomical diagnosis."},"complexity_factors":["Moderate cross-referencing: requires understanding of two separate Acts (VEA and MRCA) and their service definitions","Technical medical terminology: requires familiarity with METS (metabolic equivalents), glomerular filtration rates, and specific arthritic conditions","Temporal requirements: multiple factors include specific look-back periods (4 weeks, 10 years) that create conditional logic","Nested definitions: 'terminal event' and 'relevant service' are defined in dictionary but incorporate external statutory concepts","Dual application framework: operates across two different compensation schemes with slightly different service categories","Exclusion clause: explicitly excludes posterior adventitial heel bursitis, creating a boundary condition"],"plain_english_summary":"Establishes a standalone medical rule for veterans’ compensation claims for retrocalcaneal heel bursitis, replacing a 2015 rule that grouped it with Achilles tendinopathy. It applies to current and former Australian Defence Force members claiming under veterans’ compensation laws.\n\nIt identifies seven service‑related circumstances (e.g., intensive running, high‑impact exercise, certain inflammatory diseases, kidney failure, bursal infection, poor footwear, and lack of adequate care) that, if plausibly linked to service under the \"reasonable hypothesis\" test, can support entitlement."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument narrows and replaces the earlier 2015 Statement concerning Achilles tendinopathy and bursitis with a Statement specifically about retrocalcaneal heel bursitis (and death from it). The prior, broader instrument (No. 96 of 2015) is expressly repealed, so coverage shifts from combined Achilles conditions to a focused definition and set of service‑connection criteria for retrocalcaneal heel bursitis (Repeal; s 7)."},"complexity_factors":["Replacement of a prior instrument (repeal of Statement No. 96 of 2015) and narrower focus to retrocalcaneal heel bursitis rather than broader Achilles conditions (Repeal; s 7)","Technical medical definition and exclusion (retrocalcaneal bursitis defined; posterior adventitial heel bursitis excluded) (s 7(2))","Multiple, specific factual thresholds for raising a reasonable hypothesis (e.g. running ≥30 km/week; ≥4 hours/week of ≥5 MET activity for 4 weeks) (s 9.1–9.2)","Inclusion of discrete medical risk factors with diagnostic thresholds (listed systemic arthritic diseases; chronic renal failure defined by GFR <15 mL/min/1.73 m2 or chronic dialysis) (s 9.3–9.4)","Non‑traumatic causation and separate rules for clinical worsening where disease pre‑existed service (relationship to service; material contribution/aggravation limits) (s 10.2)","Interplay with other Statements of Principles where factors refer to other covered injuries/diseases (s 11)","Extension to death from the condition via contribution to a terminal event (terminal event defined in Schedule) (s 7(3); Schedule)","Cross‑statutory application to claims under both the VEA and MRCA and reliance on statutory terms like 'relevant service' (Application; Schedule definitions)"],"plain_english_summary":"This instrument repeals the 2015 Statement and replaces it with a Statement of Principles that defines retrocalcaneal heel bursitis (excluding posterior adventitial heel bursitis), includes death from the condition, and sets the specific medical and activity criteria that raise a reasonable hypothesis linking the condition to relevant service under the VEA or MRCA. It affects veterans and service members claiming entitlements by specifying measurable triggers — for example running ≥30 km/week, ≥4 hours/week of ≥5 MET weight‑bearing activity for 4 weeks, listed systemic arthritides, chronic renal failure, infected bursa, footwear pressure, or lack of appropriate clinical care."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-retrocalcaneal-heel-bursitis-reasonable-hypothesis-no-88-of-2024","history":"/api/acts/statement-of-principles-concerning-retrocalcaneal-heel-bursitis-reasonable-hypothesis-no-88-of-2024/history","analysis":"/api/acts/statement-of-principles-concerning-retrocalcaneal-heel-bursitis-reasonable-hypothesis-no-88-of-2024/analysis","conflicts":"/api/acts/statement-of-principles-concerning-retrocalcaneal-heel-bursitis-reasonable-hypothesis-no-88-of-2024/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-retrocalcaneal-heel-bursitis-reasonable-hypothesis-no-88-of-2024/important-cases","documents":"/api/acts/statement-of-principles-concerning-retrocalcaneal-heel-bursitis-reasonable-hypothesis-no-88-of-2024/documents"}}