{"id":"F2025L00720","name":"Statement of Principles concerning spondylolisthesis and spondylolysis (Reasonable Hypothesis) (No. 56 of 2025)","slug":"statement-of-principles-concerning-spondylolisthesis-and-spondylolysis-reasonable-hypothesis-no-56-o","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442859,"registerId":"F2025L00720-fast-fetch-1775957790106","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 (Reasonable Hypothesis) (No. 56 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  (Reasonable Hypothesis)\n\n(No. 56 of 2025)\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 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   \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 (Reasonable Hypothesis) (No. 56 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(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning spondylolisthesis and spondylolysis (Reasonable Hypothesis) (No. 24 of 2017) (Federal Register of Legislation No. F2017L00165) 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 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:\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 attracts 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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that spondylolisthesis or spondylolysis and death from spondylolisthesis or spondylolysis 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 spondylolisthesis or spondylolysis or death from spondylolisthesis or spondylolysis 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(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                             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)          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                               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":"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":true,"description":"This instrument expressly repeals the 2017 Statement of Principles for the same conditions and replaces it (section 4). Compared with a generic Statement of Principles purpose (setting medical criteria to link conditions to service), this version adds and clarifies multiple specific factors and temporal qualifications: it (a) explicitly includes death from a terminal event contributed to by the condition (section 7(5)), (b) sets a discrete BMI rule (BMI≥30 for 5 years) for degenerative anterolisthesis (section 9(10)), (c) includes prior spinal fusion and specified spine surgeries as qualifying factors (sections 9(5)–(6)), (d) codifies an age‑limited repetitive activity pathway (under 25, 10 hours/week for 6 months) (section 9(4)), and (e) recognises inability to obtain appropriate clinical management as a factor for clinical worsening (section 9(11)). These additions and clarifications broaden the practical scope of the test by specifying more pathways and documentary requirements for claimants and decision-makers, so the instrument’s operational scope has changed from the earlier instrument it repeals."},"complexity_factors":["Single Schedule with 7 key defined terms (Schedule 1).","Clear, enumerated list of 11 alternative factors in section 9 (multiple conditional pathways).","Age‑limited criterion (under 25) with quantitative exposure threshold (10 hours/week for 6 months).","Time windows and durations: 1 year (trauma), 6 months (repetitive activity), 5 years (BMI history).","Distinction between clinical onset and clinical worsening with different application rules (section 10).","Cross-reference to other Statements of Principles when factors invoke other diseases (section 11).","References to external classification (ICD-10-AM) and medical concepts (degenerative subtypes, spondylosis exclusion).","Non‑precise terms requiring medical judgment (\"inability to obtain appropriate clinical management\", \"clinical worsening\")."],"plain_english_summary":"**What this instrument does (mechanically)**\n\n- Establishes a Statement of Principles (medical test) that the Repatriation Medical Authority (RMA) says decision-makers must use when considering whether spondylolisthesis or spondylolysis (or death from those conditions) can be connected to a person’s military service for the purposes of veterans’ compensation and support (applies to claims under the VEA and the MRCA) (see sections 3, 5, 7).  \n\n- Repeals the earlier 2017 Statement of Principles for the same conditions and replaces it with this version (section 4).  \n\n- Defines the medical meaning of spondylolisthesis and spondylolysis for this test, explains that death may be included where a terminal event was contributed to by those conditions, and identifies specific medical codes as reference only (section 7(2)–(4), Schedule 1).  \n\n- Lists the specific factual or medical “factors” which, if at least one is present, are sufficient to raise a “reasonable hypothesis” that the condition is related to service (section 9).  \n\n- Requires that any factor relied on must be related to the person’s relevant service (section 10).  \n\n- Where a listed factor refers to some other injury or disease that itself has its own RMA Statement of Principles, the other Statement of Principles applies too (section 11).\n\n**Who this affects**\n\n- Veterans, members of the Australian Defence Forces, and members of Peacekeeping Forces who make claims under the Veterans’ Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA) for spondylolisthesis, spondylolysis, or death from those conditions (sections 3, 5, Schedule 1 definitions of relevant service).  \n\n- Decision-makers in the Department of Veterans’ Affairs (DVA), medical reviewers and tribunals, because they will use this Statement of Principles as the medical standard for establishing a causal link between the condition and service (sections 3, 9, 10).  \n\n- Claimants and their advisers, who must present evidence that one or more of the prescribed factors existed and that the factor(s) are related to relevant service (section 9, section 10).\n\n**What factors will establish a reasonable hypothesis (summary of section 9)**\n\nAt least one of the following must be shown:  \n- High-impact trauma to the spine causing an acute fracture of the vertebral arch at the time of clinical onset or worsening; or high-impact trauma within one year before clinical onset/worsening causing fracture or dislocation (section 9(1)–(2).)  \n- Trauma to the affected spine region at time of clinical worsening of spondylolytic spondylolisthesis (section 9(3).)  \n- For persons under 25 only: engaging in repetitive, forceful spinal hyperextension/twisting against resistance for an average of at least 10 hours/week over the 6 months before onset or worsening (examples listed in notes) (section 9(4).)  \n- Prior spinal fusion or surgical procedures that remove or damage parts of the vertebral arch or facet joints before clinical onset/worsening (section 9(5)–(6).)  \n- Presence of spondylosis at the affected level before onset/worsening of degenerative spondylolisthesis (section 9(7).)  \n- Pathological damage to the vertebra (for example infection, tumour, osteoporosis) at onset/worsening (section 9(8).)  \n- Rheumatoid arthritis involving the affected vertebra at onset/worsening (section 9(9).)  \n- A Body Mass Index (BMI) of 30 or greater for the 5 years before onset/worsening of degenerative anterolisthesis (section 9(10) and associated notes explaining BMI calculation).  \n- Inability to obtain appropriate clinical management for the condition before clinical worsening (section 9(11).)\n\n**How the link to service must work**\n\n- Any one of the above factors must be tied to the person’s relevant service (operational, peacekeeping, hazardous, British nuclear test defence under the VEA, or warlike/non‑warlike under the MRCA) (section 10; Schedule 1 definition of relevant service).  \n\n- The provisions about “clinical worsening” are limited to situations where the condition existed before or during service (but did not arise out of that service) and the service materially contributed to or aggravated the condition (section 10(2)).\n\n**Why the RMA says it matters (their stated basis)**\n\n- The RMA states it has sound medical-scientific evidence that spondylolisthesis and spondylolysis, and death from those conditions, can be related to relevant military service (section 8).  \n\n**Practical effects, incentives and trade-offs (testing the RMA’s expressed purpose against costs and mechanics)**\n\n- Who pays / who decides: The RMA sets this medical standard; the DVA (and related decision-makers and tribunals) apply it when deciding entitlement to benefits and compensation. If a claimant can show one of the listed factors and tie it to service, DVA decision-makers will usually accept that a reasonable hypothesis exists and proceed with entitlement assessment (sections 3, 9–11).  \n\n- Evidence and compliance burden: The instrument is concrete about what counts (e.g. trauma within one year, 10 hours/week for 6 months for those under 25, BMI≥30 for 5 years, specific surgeries). That narrows medical judgments but shifts the burden onto claimants to produce records: accident reports, surgical notes, clinical records, employment/training logs, height/weight records over time, and evidence of inability to access care (section 9; Schedule 1 notes on BMI and examples of activities).  \n\n- Administrative discretion and interpretation risk: Key terms such as “clinical onset”, “clinical worsening”, “inability to obtain appropriate clinical management”, and tying a factor to “relevant service” require factual and medical judgement by reviewers. That creates scope for variations in decision-making and appeals where evidence is borderline (sections 9–10).  \n\n- Concentration of benefits vs diffuse costs: The listed factors tend to create clear entitlement pathways for claimants with a discrete traumatic event or surgical history (concentrated, documentable cases). Diffuse situations (gradual degeneration without clear prior spondylosis, borderline BMI history, or subjective inability to access care) may be harder to prove and create more administrative work.  \n\n- Interaction with other Statements of Principles: If a factor points to another injury/disease that has its own RMA Statement of Principles, that other SOP also governs the assessment. That can simplify or complicate cases depending on the overlap (section 11).  \n\n- Effects on private choices and markets: The instrument does not directly regulate employers or sports bodies, but it makes particular sporting or occupational histories (e.g., repetitive forceful extension in young people) more relevant to claims. That may influence the kinds of evidence provided by sporting organisations, schools, or employers when assisting a claimant (section 9(4) and notes).  \n\n- Opportunity costs: DVA will need resources to examine historical clinical and lifestyle evidence (weight records, activity history, surgical notes). Claimants may need to obtain or reconstruct records, seek expert medical reports, or pursue appeals.\n\n**Key definitional points to watch**\n\n- Spondylosis is explicitly excluded from the definitions of spondylolisthesis and spondylolysis for this instrument (section 7(2)).  \n- Death is included only where the condition contributed to a terminal event as defined (for example pneumonia, respiratory failure, cardiac arrest) (section 7(5); Schedule 1 definition of terminal event).  \n- The younger‑person repetitive-activity criterion is limited to those under 25 and specifies an average weekly threshold and duration (section 9(4) and notes).  \n\n**Section references**: The main mechanics are in sections 3–11 and the Schedule 1 definitions; the list of factors is in section 9; relationship-to-service rules are in section 10."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement instrument maintaining the established scope of Repatriation Medical Authority Statements of Principles. It updates the 2017 version without expanding beyond the original purpose of defining service-connected factors for specific spinal conditions. The structure, factor types (trauma, repetitive stress, comorbidities, surgery), and target population remain consistent with the original legislative framework under section 196B(2) of the Veterans' Entitlements Act 1986."},"complexity_factors":["Moderate cross-referencing between the main body and Schedule 1 (Dictionary)","12 distinct factors with multiple sub-clauses and temporal conditions (e.g., 'within 1 year', 'for 6 months', 'for 5 years')","Age-restricted factor (under 25 years) with specific activity thresholds (10 hours/week for 6 months)","Mathematical formula embedded (BMI calculation: W/H²)","Multiple defined terms (9 definitions in Schedule 1) including nested definitions","Conditional logic distinguishing 'clinical onset' from 'clinical worsening' and different service connection rules for each","Reference to external classification system (ICD-10-AM Tenth Edition) with specific ISBN","Interaction clause with other Statements of Principles (section 11)"],"plain_english_summary":"This instrument replaces the 2017 medical rules and sets 12 specific factors that, if proven, create a \"reasonable hypothesis\" that spondylolisthesis or spondylolysis is connected to military service. The test is a lower threshold than proving direct causation.\n\nIt affects veterans and current/former defence members claiming under the Veterans' Entitlements Act 1986 or the Military Rehabilitation and Compensation Act 2004, and tells the Department of Veterans' Affairs what evidence will justify acceptance of claims."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-spondylolisthesis-and-spondylolysis-reasonable-hypothesis-no-56-o","history":"/api/acts/statement-of-principles-concerning-spondylolisthesis-and-spondylolysis-reasonable-hypothesis-no-56-o/history","analysis":"/api/acts/statement-of-principles-concerning-spondylolisthesis-and-spondylolysis-reasonable-hypothesis-no-56-o/analysis","conflicts":"/api/acts/statement-of-principles-concerning-spondylolisthesis-and-spondylolysis-reasonable-hypothesis-no-56-o/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-spondylolisthesis-and-spondylolysis-reasonable-hypothesis-no-56-o/important-cases","documents":"/api/acts/statement-of-principles-concerning-spondylolisthesis-and-spondylolysis-reasonable-hypothesis-no-56-o/documents"}}