{"id":"F2023L00917","name":"Statement of Principles concerning thoracolumbar intervertebral disc prolapse (Reasonable Hypothesis) (No. 68 of 2023)","slug":"statement-of-principles-concerning-thoracolumbar-intervertebral-disc-prolapse-reasonable-hypothesis-","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441986,"registerId":"F2023L00917-fast-fetch-1775957131079","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning thoracolumbar intervertebral disc prolapse (Reasonable Hypothesis) (No. 68 of 2023)","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\n\n \n\nStatement of Principles\n\nconcerning\n\nTHORACOLUMBAR INTERVERTEBRAL DISC PROLAPSE (Reasonable Hypothesis)\n\n(No. 68 of 2023)\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 23 June 2023.\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:
|\n| --- |\n|
Professor Terence Campbell AM
Chairperson
|\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\n1 Name\n\nThis is the Statement of Principles concerning thoracolumbar intervertebral disc prolapse (Reasonable Hypothesis) (No. 68 of 2023).\n\n2 Commencement\n\n This instrument commences on 25 July 2023.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning intervertebral disc prolapse (Reasonable Hypothesis) (No. 43 of 2016) (Federal Register of Legislation No. F2016L00563) made under subsections 196B(2) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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\n6 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about thoracolumbar intervertebral disc prolapse and death from thoracolumbar intervertebral disc prolapse.\n\n(2) This Statement of Principles applies to thoracolumbar intervertebral disc prolapse that has been diagnosed on the basis of:\n\n(a) clinical manifestations of local pain and stiffness, or symptoms and signs of thoracolumbar spinal cord compression or thoracolumbar nerve root compression; and\n\n(b) imaging evidence of thoracolumbar intervertebral disc prolapse, including protrusion, herniation, extrusion or rupture of the nucleus pulposus or annulus fibrosis of a thoracolumbar intervertebral disc into the vertebral canal of the thoracolumbar spine.\n\nNote: imaging evidence of thoracolumbar intervertebral disc prolapse is defined in the Schedule 1 - Dictionary. It will usually be the case that the date of the imaging evidence of thoracolumbar intervertebral disc prolapse is after the date of clinical onset.\n\n(3) For the purposes of this Statement of Principles \"thoracolumbar intervertebral disc prolapse\" means protrusion, herniation, extrusion or rupture of the nucleus pulposus or annulus fibrosis of an intervertebral disc into the vertebral canal of the thoracolumbar spine, causing symptoms or signs, including intervertebral disc prolapses at the thoracolumbar and lumbosacral junctions.\n\n(4) The definition of thoracolumbar intervertebral disc prolapse given at subsection (3) excludes bulging of the intervertebral disc and Schmorl's nodes.\n\n(5) Whilst thoracolumbar intervertebral disc prolapse attracts ICD‑10‑AM codes M51.0, M51.1 or M51.2. In this Statement of Principles, the definition of \"thoracolumbar intervertebral disc prolapse\" is that given at subsection (3).\n\n(6) For subsection (5), 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\nDeath from thoracolumbar intervertebral disc prolapse\n\n(7) For the purposes of this Statement of Principles, thoracolumbar intervertebral disc prolapse, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's thoracolumbar intervertebral disc prolapse.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n8 Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that thoracolumbar intervertebral disc prolapse and death from thoracolumbar intervertebral disc prolapse 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\n9 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 thoracolumbar intervertebral disc prolapse or death from thoracolumbar intervertebral disc prolapse with the circumstances of a person's relevant service:\n\n(1) having trauma to the affected intervertebral disc within the 24 hours before the clinical onset of thoracolumbar intervertebral disc prolapse;\n\nNote: trauma to the affected intervertebral disc is defined in the Schedule 1 - Dictionary.\n\n(2) having a penetrating injury to the affected intervertebral disc or adjacent vertebral body, within the 24 hours before the clinical onset of thoracolumbar intervertebral disc prolapse;\n\nNote: penetrating injury to the affected intervertebral disc or adjacent vertebral body is defined in the Schedule 1 - Dictionary.\n\n(3) physically carrying or lifting loads of at least 10 kilograms, to a cumulative total Load-Factor of at least 150,000 within the 10 years before the clinical onset of thoracolumbar intervertebral disc prolapse;\n\nNote: Load-Factor is defined in the Schedule 1 - Dictionary.\n\n(4) driving a motor vehicle for an average of at least 25 hours per week, for a period of at least 2 years within the 10 years before the clinical onset of thoracolumbar intervertebral disc prolapse;\n\nNote: motor vehicle is defined in the Schedule 1 - Dictionary.\n\n(5) flying in an engine powered aircraft as operational crew, for a cumulative total of at least 2,500 hours within the 10 years before the clinical onset of thoracolumbar intervertebral disc prolapse;\n\n(6) flying in a helicopter as operational aircrew, for a cumulative total of at least 2,500 hours within the 10 years before the clinical onset of thoracolumbar intervertebral disc prolapse;\n\n(7) having smoked tobacco products in an amount of at least 5 pack-years before the clinical onset of thoracolumbar intervertebral disc prolapse, and if smoking has ceased before the clinical onset of thoracolumbar intervertebral disc prolapse, then that onset occurred within 5 years of cessation;\n\nNote: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(8) having bacterial infection of the affected disc at the time of the clinical onset of thoracolumbar intervertebral disc prolapse;\n\n(9) being obese for at least 5 years within the 25 years before the clinical onset of thoracolumbar intervertebral disc prolapse;\n\nNote: being obese is defined in the Schedule 1 - Dictionary.\n\n(10) having trauma to the affected intervertebral disc within the 24 hours before the clinical worsening of thoracolumbar intervertebral disc prolapse;\n\nNote: trauma to the affected intervertebral disc is defined in the Schedule 1 - Dictionary.\n\n(11) having a penetrating injury to the affected intervertebral disc or adjacent vertebral body, within the 24 hours before the clinical worsening of thoracolumbar intervertebral disc prolapse;\n\nNote: penetrating injury to the affected intervertebral disc or adjacent vertebral body is defined in the Schedule 1 - Dictionary.\n\n(12) physically carrying or lifting loads of at least 10 kilograms, to a cumulative total Load-Factor of at least 150,000 within the 10 years before the clinical worsening of thoracolumbar intervertebral disc prolapse;\n\nNote: Load-Factor is defined in the Schedule 1 - Dictionary.\n\n(13) driving a motor vehicle for an average of at least 25 hours per week, for a period of at least 2 years within the 10 years before the clinical worsening of thoracolumbar intervertebral disc prolapse;\n\nNote: motor vehicle is defined in the Schedule 1 - Dictionary.\n\n(14) flying in an engine powered aircraft as operational crew, for a cumulative total of at least 2,500 hours within the 10 years before the clinical worsening of thoracolumbar intervertebral disc prolapse;\n\n(15) flying in a helicopter as operational aircrew, for a cumulative total of at least 2,500 hours within the 10 years before the clinical worsening of thoracolumbar intervertebral disc prolapse;\n\n(16) having smoked tobacco products in an amount of at least 5 pack-years before the clinical worsening of thoracolumbar intervertebral disc prolapse, and if smoking has ceased before the clinical worsening of thoracolumbar intervertebral disc prolapse, then that worsening occurred within 5 years of cessation;\n\nNote: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(17) having bacterial infection of the affected disc at the time of the clinical worsening of thoracolumbar intervertebral disc prolapse;\n\n(18) being obese for at least 5 years within the 25 years before the clinical worsening of thoracolumbar intervertebral disc prolapse;\n\nNote: being obese is defined in the Schedule 1 - Dictionary.\n\n(19) inability to obtain appropriate clinical management for thoracolumbar intervertebral disc prolapse before the clinical worsening of thoracolumbar intervertebral disc prolapse.\n\n10 Relationship to service\n\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\n(2) The factors set out in subsections 9(10) to 9(19) apply only to material contribution to, or aggravation of, thoracolumbar intervertebral disc prolapse where the person's thoracolumbar intervertebral disc prolapse was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n11 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 9 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 6\n\n1 Definitions\n\nIn this instrument:\n\n being obese means having a Body Mass Index (BMI) of 30 or greater.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\n BMI means W/H2 and where:\n\n(a) W is the person's weight in kilograms; and\n\n(b) H is the person's height in metres.\n\n clinical onset means the point backwards in time from the first date of imaging confirming thoracolumbar intervertebral disc prolapse, to the date at which the symptoms of thoracolumbar intervertebral disc prolapse were persistently present, as assessed by a registered medical practitioner.\n\n imaging evidence of thoracolumbar intervertebral disc prolapse means an image of the interior of a body obtained by medical techniques, including X-ray radiography or magnetic resonance imaging, showing thoracolumbar intervertebral disc prolapse, that is usually obtained at a date after the date of clinical onset of the disease.\n\nNote: clinical onset is defined in the Schedule 1 – Dictionary.\n\n Load-Factor means W2 x T, where:\n\n(a) W is the weight of the load lifted or carried in kilograms; and\n\n(b) T is the time the load was lifted or carried in hours.\n\n motor vehicle means a motorised vehicle which imparts vibration to the whole body, such as a car, truck, motor cycle, tractor, jeep, armoured personnel carrier, tank, or a construction vehicle, such as a forklift, bulldozer, crane, steam shovel, backhoe or steam roller.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n one pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products.\n\nNote 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette.\n\nNote 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years.\n\n penetrating injury to the affected intervertebral disc or adjacent vertebral body means piercing of the affected intervertebral disc or adjacent vertebral body by an object such as a bullet, shell fragment, knife or needle.\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 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 thoracolumbar intervertebral disc prolapse—see subsection 7(3).\n\n trauma to the affected intervertebral disc means a discrete event involving the application of significant physical force to the affected intervertebral disc, that causes:\n\n(a) the development of symptoms and signs of pain and tenderness, and either altered mobility or range of movement of the thoracolumbar spine. In the case of sustained unconsciousness or the masking of pain by analgesic medication, these symptoms and signs must appear on return to consciousness or the withdrawal of the analgesic medication; and\n\n(b) the persistence of these symptoms and signs for a period of at least 7 days following their onset, save for where medical intervention for the trauma to the affected intervertebral disc has occurred and that medical intervention involves one of the following:\n\n(i) immobilisation of the thoracolumbar spine by splinting or similar external agent;\n\n(ii) injection of a corticosteroid or local anaesthetic into the thoracolumbar spine; or\n\n(iii) surgery to the thoracolumbar spine.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":7,"scope_assessment":{"changed":true,"description":"This instrument repeals the earlier Statement of Principles (No. 43 of 2016) and replaces it (s 4). It applies to claims under the VEA or MRCA (s 5) and sets defined diagnostic criteria, explicit exposure thresholds and time windows (s 7–9, Schedule). The text itself does not provide a clause‑by‑clause comparison with the 2016 instrument, so the specific substantive differences cannot be enumerated from this instrument alone; however, the repeal-and-replace indicates the operative SOP for claims has changed to the terms set out here (s 4)."},"complexity_factors":["Technical diagnostic criteria and timing: requires both clinical manifestations and imaging evidence; clinical onset is assessed backwards from first imaging (s 7(2), Schedule—clinical onset, imaging evidence).","Multiple numeric thresholds and formulas to calculate exposures (Load‑Factor W^2×T; pack‑years; BMI ≥30) create measurement and proof burdens (s 9(3),(4),(7),(9); Schedule—Load‑Factor, one pack‑year, being obese, BMI).","Cumulative and temporal windows: many factors require totals within specified lookback periods (eg 10 years, 25 years, 5 years after smoking cessation), increasing evidentiary complexity (s 9(3)–(9), (12)–(18)).","Service‑relatedness requirement: every factor must be related to the person's relevant service, shifting causal assessment to the claim context (s 10(1); Schedule—relevant service).","Distinction between causation and aggravation: subsections 9(10)–(19) only apply to material contribution or aggravation where the disorder existed before or during but did not arise out of service—this narrows applicability and adds legal nuance (s 10(2)).","Interplay with other Statements of Principles: where a listed factor refers to another injury/disease with its own SOP, that SOP governs the factor—creates cross‑referencing and potential overlap (s 11).","Discretionary evidentiary standard and authority role: RMA states it relied on 'sound medical‑scientific evidence' to set these factors, signalling expert judgement in thresholds (s 8); the instrument also repeals the 2016 SOP (s 4).","Ambiguous or subjective elements: terms like 'inability to obtain appropriate clinical management' require case‑by‑case factual assessment and may be contested (s 9(19)).","Record‑keeping and proof burdens on claimants: proving cumulative driving/flying hours, load‑lifting history, smoking pack‑years, long‑term obesity or infection requires contemporaneous records or retrospective reconstruction (s 9(3)–(7),(9),(14)–(16); Schedule definitions)."],"plain_english_summary":"This Statement of Principles sets the medical and evidentiary rules the Repatriation Medical Authority uses to decide if a thoracolumbar intervertebral disc prolapse can be reasonably linked to a person’s military, peacekeeping or defence service for VEA/MRCA claims. It defines the diagnosis and imaging requirement, then lists specific exposure and health factors (for example trauma, lifting load‑factor, driving/flying hours, smoking, obesity, infection, and failure to obtain care) that, if related to service, raise a reasonable hypothesis for entitlement."},"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"},"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"This instrument maintains the established scope of Repatriation Medical Authority Statements of Principles. It is a targeted replacement of the 2016 instrument concerning intervertebral disc prolapse, now specifically limited to the thoracolumbar region (mid-to-lower back). The scope has not expanded beyond the traditional function of these instruments: establishing service connection factors for specific medical conditions in the veterans' compensation scheme."},"complexity_factors":["19 distinct factors with specific quantitative thresholds (e.g., '150,000 Load-Factor', '25 hours per week for 2 years', '2,500 hours')","Mathematical formula definitions required (Load-Factor = W² × T; BMI = W/H²)","Dual application structure — factors apply to both 'clinical onset' and 'clinical worsening' with subtle differences","Nested definitions with cross-references (e.g., 'clinical onset' depends on 'imaging evidence' which depends back on 'clinical onset' timing)","Conditional logic in definitions (e.g., trauma definition has 7-day persistence rule with three specific medical intervention exceptions)","Temporal limitation clauses varying by factor (24 hours, 10 years, 25 years, 5-year smoking cessation window)","Exclusion clauses in the condition definition (specifically excludes 'bulging' and 'Schmorl's nodes')","Interaction clause with other Statements of Principles (Section 11 creates dynamic referencing to other instruments)","Specific ICD-10-AM code references with edition locking (Tenth Edition, 1 July 2017 effective date)"],"plain_english_summary":"This instrument updates the medical rules for claiming compensation for thoracolumbar intervertebral disc prolapse (a middle‑to‑lower back slipped disc), replacing the 2016 Statement of Principles and defining the condition by symptoms and imaging. It lists 19 specific service‑related factors that can create a \"reasonable hypothesis\" the condition is linked to military service.\n\nIt applies to veterans, peacekeepers and current/former Defence Force members and serves as the gatekeeper for accepting or rejecting claims under the VEA and MRCA."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-thoracolumbar-intervertebral-disc-prolapse-reasonable-hypothesis-","history":"/api/acts/statement-of-principles-concerning-thoracolumbar-intervertebral-disc-prolapse-reasonable-hypothesis-/history","analysis":"/api/acts/statement-of-principles-concerning-thoracolumbar-intervertebral-disc-prolapse-reasonable-hypothesis-/analysis","conflicts":"/api/acts/statement-of-principles-concerning-thoracolumbar-intervertebral-disc-prolapse-reasonable-hypothesis-/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-thoracolumbar-intervertebral-disc-prolapse-reasonable-hypothesis-/important-cases","documents":"/api/acts/statement-of-principles-concerning-thoracolumbar-intervertebral-disc-prolapse-reasonable-hypothesis-/documents"}}