{"id":"F2025L00721","name":"Statement of Principles concerning spondylolisthesis and spondylolysis (Balance of Probabilities) (No. 57 of 2025)","slug":"statement-of-principles-concerning-spondylolisthesis-and-spondylolysis-balance-of-probabilities-no-5","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442858,"registerId":"F2025L00721-fast-fetch-1775957790103","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning spondylolisthesis and spondylolysis (Balance of Probabilities) (No. 57 of 2025)","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\nSPONDYLOLISTHESIS AND SPONDYLOLYSIS  (Balance of Probabilities)\n\n(No. 57 of 2025)\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 20 June 2025\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 spondylolisthesis and spondylolysis (Balance of Probabilities) (No. 57 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 21 July 2025.\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 spondylolisthesis and spondylolysis (Balance of Probabilities) (No. 25 of 2017) (Federal Register of Legislation No. F2017L00167) 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 spondylolisthesis and spondylolysis and death from spondylolisthesis and spondylolysis.\n\n\nMeaning of spondylolisthesis and spondylolysis\n\n1.           For the purposes of this Statement of Principles, spondylolisthesis and spondylolysis:\n\n\nspondylolisthesis:\n\n1.           means forward displacement (anterolisthesis) or backward displacement (retrolisthesis) of one vertebra over the vertebra below; and\n2.           excludes spondylosis.\n\n\nspondylolysis:\n\n1.            means a defect or fracture, unilateral or bilateral, involving the pars interarticularis of a vertebra;\n\n\n1.            excludes spondylosis.\n\n\n1.           While spondylolisthesis ICD‑10‑AM code M43.1 and spondylolysis attracts ICD‑10‑AM code M43.0, in applying this Statement of Principles the meaning of spondylolisthesis and spondylolysis is that given in subsection (2).\n2.           For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.\n\n\nDeath from spondylolisthesis or spondylolysis\n\n1.           For the purposes of this Statement of Principles, spondylolisthesis or spondylolysis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's spondylolisthesis or spondylolysis.\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 spondylolisthesis or spondylolysis and death from spondylolisthesis or spondylolysis 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, spondylolisthesis or spondylolysis or death from spondylolisthesis or spondylolysis is connected with the circumstances of a person's relevant service:\n\n1.           experiencing a high impact trauma to the spine resulting in an acute fracture of the vertebral arch at the time of clinical onset or clinical worsening;\n2.           experiencing a high impact trauma to the spine resulting in an acute fracture of the vertebral arch or dislocation of the involved vertebra within the 1 year before clinical onset or clinical worsening of spondylolisthesis;\n3.           having trauma to affected region of the spine at the time of clinical worsening of spondylolytic spondylolisthesis;\n\n\nNote 1: Examples of trauma include, but are not limited to, vehicle accident, fall or sports injury.\n\nNote 2: spondylolytic spondylolisthesis is defined in the Schedule 1 - Dictionary. \n\n1.           for persons less than 25 years of age only, engaging in activities involving repetitive and forceful hyperextension, torsion or rotation against resistance of the spine for an average period of at least 10 hours per week for the 6 months before clinical onset or clinical worsening of spondylolysis or spondylolytic spondylolisthesis;\n\n\nNote 1: spondylolytic spondylolisthesis is defined in the Schedule 1 - Dictionary. \n\nNote 2: Examples of activities involving repetitive and forceful hyperextension, torsion or rotation against resistance include gymnastics, pole vaulting, dancing, weightlifting, weight training, wrestling, judo, horse riding, swimming and playing football, tennis, volleyball, basketball, golf and cricket.\n\n1.           having undergone a spinal fusion of a segment of adjacent vertebrae to permanently connect 2 or more vertebrae in the spine, eliminating motion between them before clinical onset;\n2.           having undergone spinal surgery involving resection of the facet joints or parts of the vertebral arch (including laminectomy, laminotomy and facetectomy) at the level of the involved vertebra, or surgery to the spine that damages the integrity and stability of the spine at the level of the involved vertebra before clinical onset or clinical worsening;\n3.           having spondylosis at the level of the involved vertebra, before clinical onset or clinical worsening of degenerative spondylolisthesis of the lumbar or cervical spine;\n\n\nNote: degenerative spondylolisthesis is defined in the Schedule 1 - Dictionary\n\n1.           having pathological damage to the affected vertebra at the time of clinical onset or clinical worsening;\n\n\nNote: Pathological damage to a vertebra can occur due to a local or systemic disease process which significantly weakens or destroys the vertebral bone, including benign and malignant tumours, tuberculosis, osteomyelitis, osteoporosis and Paget disease.\n\n1.           having rheumatoid arthritis involving the affected vertebra at the time of clinical onset or clinical worsening of spondylolisthesis;\n2.       having a Body Mass Index (BMI) of 30 or greater for the 5 years before clinical onset or clinical worsening of degenerative anterolisthesis;\n\n\nNote 1: Body Mass Index (BMI) is calculated as W/H2 where:\n\n1.         W is the person's weight in kilograms; and\n\n\n1.        H is the person's height in metres.\n\n\nNote 2: degenerative anterolisthesis is defined in the Schedule 1 - Dictionary.\n\n1.       inability to obtain appropriate clinical management for spondylolisthesis or spondylolysis 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, spondylolisthesis or spondylolysis where the person's spondylolisthesis or spondylolysis 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                               degenerative anterolisthesis means forward displacement of one vertebra over the vertebra below due to segmental instability arising from osteoarthritis of the facet joints.\n\n                               degenerative spondylolisthesis means forward or backward displacement of one vertebra over the vertebra below due to segmental instability arising from osteoarthritis of the facet joints.\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 also defined in the Schedule 1 - Dictionary.\n\n                               spondylolisthesis and spondylolysis—see subsection 7(2).\n\n                               spondylolytic spondylolisthesis means spondylolisthesis which develops where there is pre-existing spondylolysis of the affected vertebra.\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"},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument replaces the 2017 Statement (s4) and, compared with a generic earlier Statement of Principles approach, appears to broaden and sharpen the list of qualifying factors. Notable expansions and clarifications in this version include: an explicit BMI threshold (BMI ≥30 for 5 years) tied to degenerative anterolisthesis (s9), specific surgical history as qualifying factors (spinal fusion and resection surgeries) (s9(5)–(6)), an explicit factor for inability to obtain appropriate clinical management (s9(11)), and a detailed, age‑limited repetitive activity criterion for under‑25s with a quantitative hours/week and 6‑month window (s9(4)). The instrument also clarifies death‑coverage by linking the condition to terminal events (Schedule 1). These additions expand the range of factual circumstances that can establish service connection and increase evidentiary specificity compared with a bare restatement of causation principles. This assessment is based on the content of the current instrument and the fact it expressly repeals the 2017 Statement; a precise side‑by‑side comparison with the 2017 text would confirm the exact scope changes."},"complexity_factors":["Relatively short instrument (11 numbered sections plus Schedule) but with multiple substantive factors in section 9","11 separate causation factors listed in section 9, some with sub‑conditions (trauma timing windows, age‑limit, BMI timeframe)","Defined terms in Schedule 1 (e.g. degenerative anterolisthesis, degenerative spondylolisthesis, spondylolytic spondylolisthesis, terminal event, MRCA, relevant service, VEA) create interpretive dependencies","Conditional logic for \"clinical worsening\" and its limited application to pre‑existing conditions (s10(2))","Cross‑reference to other Statements of Principles where factors refer to other injuries/diseases (s11) — increases inter‑instrument linkage","Reference to external classification (ICD‑10‑AM) though legal meaning is instrumentally defined (s7(3))","Specific evidentiary timeframes and quantitative thresholds (eg. 10 hours/week for 6 months; BMI ≥30 for 5 years) requiring retrospective factual findings","Inclusion of death via contribution to a terminal event requires linking the condition to proximate causes of death (Schedule 1 \"terminal event\")"],"plain_english_summary":"**What this instrument does (mechanical changes)\n\n- Replaces an earlier Statement of Principles for spondylolisthesis and spondylolysis and takes effect 21 July 2025 (see Repeal and Commencement). (s2, s4)\n- Applies to claims under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act (claims processes in which medical causation is assessed). (s5)\n- Defines what the terms \"spondylolisthesis\" and \"spondylolysis\" mean for the purposes of veterans' claims and expressly excludes spondylosis. (s7(2))\n- Lists the specific medical and exposure \"factors\" — at least one of which must be present for the Repatriation Medical Authority (RMA) to say, on the balance of probabilities, that the condition is related to a person’s relevant service. (s8, s9)\n- Clarifies that death is covered where the condition contributed to a terminal event (for example, pneumonia or respiratory failure). (Schedule 1 definition of \"terminal event\")\n- States that if any factor refers to another injury or disease already covered by a separate Statement of Principles, the rules in that other Statement apply. (s11)\n\n**Who this affects\n\n- Veterans and current or former members of the Australian Defence Force who lodge claims under the VEA or the MRCA for spondylolisthesis, spondylolysis, or death contributed to by those conditions. (s5)\n- The Department handling claims and medical assessors who must apply these criteria when deciding whether a condition is service‑connected. (s3, s8)\n\n**How it works (key factors and evidentiary mechanics)\n\n- The RMA sets the medical threshold: it must be \"more probable than not\" that the condition can be related to relevant service (balance of probabilities). (s8)\n- At least one of the following must be shown and be linked to the person's relevant service: (s9)\n  - High‑impact trauma to the spine causing an acute fracture of the vertebral arch at the time symptoms start or worsen; or such trauma within 1 year before onset/worsening causing fracture or vertebral dislocation. (s9(1)–(2))\n  - Trauma to the affected spinal region at the time a pre‑existing spondylolysis worsens to spondylolytic spondylolisthesis. (s9(3))\n  - For people under 25 only: engaging in repetitive, forceful spinal hyperextension/torsion/rotation against resistance averaging at least 10 hours/week for 6 months before onset/worsening (examples given: gymnastics, weightlifting, some ball sports, horse riding, dancing). (s9(4))\n  - Prior spinal fusion (permanent connection of adjacent vertebrae) before clinical onset. (s9(5))\n  - Prior spinal surgery that removes part of the vertebral arch or facet joints, or other surgery that damages spinal stability at the involved level, before onset/worsening. (s9(6))\n  - Pre‑existing spondylosis at the involved level before onset/worsening of degenerative spondylolisthesis. (s9(7))\n  - Pathological damage to the affected vertebra at the time of onset/worsening (for example, tumours, infection, osteoporosis). (s9(8))\n  - Rheumatoid arthritis involving the affected vertebra at onset/worsening. (s9(9))\n  - Body Mass Index (BMI) of 30 or greater for the 5 years before onset/worsening of degenerative anterolisthesis. (s9(10))\n  - Inability to obtain appropriate clinical management for the condition before clinical worsening. (s9(11))\n- The factor shown must be related to the person's \"relevant service\" (see Schedule 1 for what counts as relevant service), and the clinical‑worsening rules apply only where the condition existed before or during service but did not arise out of service. (s10)\n- The Statement refers to ICD‑10‑AM codes as identifiers but relies on the instrument's own definitions for legal meaning. (s7(3))\n\n**Official rationale and how it bears on incentives, costs and implementation\n\n- Officially, the RMA says that current medical evidence supports a conclusion that spondylolisthesis and spondylolysis can be related to relevant service on the balance of probabilities. (s8)\n- Who decides: the RMA sets the Statement; decision makers (claims assessors and medical examiners) apply it to individual claims. (s3, s8)\n- Who pays or is affected financially: if a claim succeeds, veterans may receive entitlements paid under VEA/MRCA schemes; administrative and medical assessment costs fall on government agencies handling claims. (s5)\n- Evidence and compliance burden: claimants will need to produce medical records, radiology reports, surgical records, BMI/weight history, or credible evidence of activity levels (particularly for the <25, 10‑hours/week factor). The requirement to show inability to obtain appropriate clinical management could require proof of attempts to access care. (s9(4), s9(5), s9(10), s9(11))\n- Discretion and uncertainty: terms like \"high impact trauma\", \"clinical onset or clinical worsening\", and the requirement that a factor be \"related to relevant service\" require medical and legal interpretation in each case, creating room for discretionary assessment by medical panels and review bodies. (s9, s10)\n- Implementation risk and verification difficulty: retrospective quantification of activity hours, reconstructing BMI over a 5‑year period, and attributing a terminal event to contribution by spondylolisthesis/spondylolysis all create practical evidentiary challenges. (s9(4), s9(10), Schedule 1 terminal event)\n- Interaction with other Statements of Principles: if a listed factor points to another injury/disease covered by a different Statement, the rules of that other Statement apply. That creates cross‑instrument dependency and requires assessors to consult multiple Statements. (s11)\n\n**Trade‑offs, incentives and likely behavioural effects (mechanisms, not value judgements)\n\n- Concentrated benefits: the instrument concentrates benefits on claimants who can produce the specific forms of evidence listed (trauma, surgery, long‑run high BMI, documented inability to obtain care, or documented repetitive sports/work exposures for younger people). (s9)\n- Administrative costs and shifting incentives: adding clear, evidence‑based factors can streamline decision making where documentation exists but increases administrative effort where proof is incomplete. The BMI and activity‑hours criteria, for example, favour claimants with longitudinal health/sports records while disadvantaging those without such records. (s9(4), s9(10))\n- Effects on private sector: limited direct effect on private business; private medical providers' records and reports become key evidence in claims. Insurers or employers may be indirectly affected where their records bear on causation enquiries.\n\n**Practical points for claimants and advisers\n\n- Assemble objective medical documentation (imaging, surgical and hospital records, rheumatology records, weight/BMI history, records of trauma, and statements about access to care). (s9)\n- For under‑25 applicants relying on repetitive sport/physical exposure, document frequency/duration and nature of activities over the 6 months before onset/worsening. (s9(4))\n- Where a factor points to another Statement of Principles, check that instrument too. (s11)\n\n(References in parentheses are to the section numbers of the Statement of Principles provided.)"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard Statement of Principles replacement (2017 version repealed, 2025 version commenced). The scope remains consistent with the original intent under the Veterans' Entitlements Act 1986: establishing medical criteria for linking specific spinal conditions to military service. No significant scope creep is evident."},"complexity_factors":["Multiple defined terms in Schedule 1 (9 definitions including nested definitions like 'degenerative anterolisthesis' and 'spondylolytic spondylolisthesis')","Cross-references between sections (e.g., section 9 factors reference definitions in Schedule 1)","Conditional age restrictions (factor 9(d) applies only to persons under 25 years)","Dual legislative framework application (VEA and MRCA with different service definitions)","Medical terminology requiring clinical interpretation (ICD-10-AM codes, anatomical references like 'pars interarticularis')","Temporal requirements with specific timeframes (1 year before, 6 months before, 5 years before)","Distinction between clinical onset and clinical worsening with different rules for each","Exclusion clauses (spondylolisthesis excludes spondylosis; spondylolysis excludes spondylosis)"],"plain_english_summary":"This instrument sets the medical test used by the Repatriation Medical Authority to decide if spondylolisthesis or spondylolysis in veterans and defence personnel is compensable under the VEA or MRCA. It replaces the 2017 version and requires proving, on the balance of probabilities, that service caused the condition by meeting one of 12 specified factors.\n\nExamples of relevant factors include high‑impact spinal trauma, repetitive forceful spinal loading in young athletes, prior spinal surgery, obesity for degenerative cases, other spinal disease, or inadequate treatment."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-spondylolisthesis-and-spondylolysis-balance-of-probabilities-no-5","history":"/api/acts/statement-of-principles-concerning-spondylolisthesis-and-spondylolysis-balance-of-probabilities-no-5/history","analysis":"/api/acts/statement-of-principles-concerning-spondylolisthesis-and-spondylolysis-balance-of-probabilities-no-5/analysis","conflicts":"/api/acts/statement-of-principles-concerning-spondylolisthesis-and-spondylolysis-balance-of-probabilities-no-5/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-spondylolisthesis-and-spondylolysis-balance-of-probabilities-no-5/important-cases","documents":"/api/acts/statement-of-principles-concerning-spondylolisthesis-and-spondylolysis-balance-of-probabilities-no-5/documents"}}