Statement of Principles concerning femoroacetabular impingement syndrome (Balance of Probabilities) (No. 4 of 2026)

The instrument contains several definitions and operational concepts critical to its application. The primary concept is the condition itself: femoroacetabular impingement syndrome (FAIS). Subsection 7(3) defines it as a disorder of the hip due to abnormal contact between the proximal femur and the acetabulum, in the presence of relevant symptoms and corresponding clinical signs, and abnormal morphology at the hip joint that leads to impingement. The symptoms include motion related or position related pain in the hip or groin, possibly with clicking, catching, locking, stiffness, restricted range of motion or giving way. Clinical signs include positive hip impingement tests, limited range of motion, gait abnormalities, and weakness or tenderness. Imaging must show abnormal morphology such as cam morphology or pincer morphology. Cam morphology is defined in the dictionary as a flattening or convexity at the femoral head neck junction, or a non spherical femoral head with an abnormal femoral head neck offset. Pincer morphology is defined as global or focal overcoverage of the femoral head by the acetabulum. Notably, the diagnosis requires both clinical findings and imaging; subjective symptoms alone or imaging alone are insufficient. Note 1 to subsection 7(2) observes that the date of imaging findings will usually be after the date of clinical onset, which has implications for the temporal ordering of evidence.

The concept of “clinical onset” is defined in the dictionary as the point backwards in time from the first date of imaging findings of abnormal morphology at the hip joint, to the date at which the symptoms of FAIS were persistently present, as assessed by a registered medical practitioner. This is a retrospective determination. It does not require that symptoms were continuous from that point, only that they were persistently present at the time the symptoms began. This definition may create evidentiary challenges because it relies on a medical opinion about when symptoms became persistent, often long before imaging was conducted.

“Relevant service” is a defined term critical to the instrument’s scope. It means (a) eligible war service (other than operational service) under the VEA, (b) defence service (other than hazardous service and British nuclear test defence service) under the VEA, or (c) peacetime service under the MRCA. This narrows the SoP to service types where the standard of proof is the balance of probabilities, not reasonable hypothesis. It does not cover operational service under the VEA or hazardous service, which would be governed by a separate SoP under the reasonable hypothesis standard.

The factors in section 9 are the operative provisions. Factor 9(1) requires weight bearing exercise involving repeated activity of the hip on the affected side at a minimum intensity of 8 METs for at least 6 hours per week, for a cumulative period of at least 5 years before the clinical onset. The note lists examples of activities at that intensity: competitive soccer, competitive football, basketball, vigorous downhill skiing, hockey, vigorous calisthenics and martial arts. Factor 9(2) uses the same exercise requirement but for at least 1 year before clinical worsening. Factor 9(3) is inability to obtain appropriate clinical management for FAIS before clinical worsening. The instrument does not define “appropriate clinical management” or “inability to obtain” it, which leaves room for interpretation. The clinical worsening factors are limited by subsection 10(2) to cases where the FAIS was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

This SoP directly affects veterans and members of the Australian Defence Force who have rendered, or are rendering, “relevant service” as defined, and who develop or have developed FAIS. The instrument is one of the tools used by the DVA and the Military Rehabilitation and Compensation Commission (MRCC) to determine eligibility for compensation under the VEA and MRCA. It therefore affects both claimants and the decision makers who assess their claims.

For claimants, the SoP imposes a burden of proof on the balance of probabilities. They must establish that they have at least one of the three factors and that the factor is related to their service. This requires them to produce evidence of their exercise history, including the type, intensity, duration and cumulative period of weight bearing exercise, or evidence of inability to obtain appropriate clinical management. They must also provide medical evidence of the diagnosis, including symptoms, clinical signs and imaging, and medical opinion on the date of clinical onset or worsening.

For medical practitioners, the SoP creates a framework for giving opinions on causation. The definition of clinical onset requires an assessment by a registered medical practitioner of when symptoms were persistently present, going backwards from the first imaging date. This may be difficult in practice if records are sparse or if the patient only presented late. The exercise intensity of 8 METS is a specific threshold, and practitioners may need to rely on records or patient recall of activities.

For decision makers within DVA, the Veterans’ Review Board and the Administrative Appeals Tribunal, the SoP is binding. It limits the range of accepted causal pathways to those listed. If a claimant’s FAIS cannot be linked to service through one of the three factors, the decision maker cannot find in the claimant’s favour on the balance of probabilities unless there is other compelling evidence that the condition is related to service,but the SoP is intended to be exhaustive of the sound medical scientific evidence routes. In practice, this means that claims that do not meet the exercise thresholds face significant hurdles.

For the RMA, the instrument reflects its statutory function to keep SoPs up to date. The repeal of the 2017 version and replacement with this 2026 version implies that the medical evidence base has changed, although the instrument itself does not detail what changed. The RMA is not directly affected in administration, but its decisions shape the compensation system’s costs.

For taxpayers, the SoP has an indirect effect: it determines the circumstances under which public money is paid out for compensation and medical expenses. The exercise factor, requiring high intensity activity over years, likely captures only a subset of claimants. Those who develop FAIS from lower intensity activities or from non exercise causes (such as structural abnormalities present from birth, or from other activities) may be excluded even if there is a genuine service connection. This creates allocative effects: it concentrates compensation on those with high physical demands in service, potentially undercompensating others.

The instrument does not impose duties directly on individuals. It is a legislative rule that confers entitlements indirectly by setting the standard for proof. The key duty it establishes is on the RMA to have determined the SoP on the basis of sound medical scientific evidence, as required by the VEA. The instrument itself recites that the RMA is of the view that it is more probable than not that FAIS can be related to relevant service. The RMA has no ongoing duty under this instrument beyond its determination; the duty to apply it rests with others.

For claimants, the instrument creates a right to have their claim assessed in accordance with its terms. Under sections 120B of the VEA and 339 of the MRCA, the decision maker must apply the SoP to determine whether the condition is related to service. If at least one factor is met, the claimant is entitled to a finding in their favour on the balance of probabilities, subject to the factor being related to service. This is a procedural right that reduces discretion; it is a right to a structured decision making process, not a guarantee of compensation.

For decision makers, there is a duty to correctly interpret and apply the SoP. This includes correctly determining the date of clinical onset or worsening, verifying that the exercise factor meets the MET and duration thresholds, and ensuring that the factor is related to the person’s relevant service. The decision maker must also apply the dictionary definitions and the other interpretive rules, such as section 11 on factors referring to another injury or disease covered by another SoP.

The instrument also creates a duty of consistency: the decision maker must apply the same SoP to all claims for FAIS under the relevant provisions. This reduces the potential for arbitrary outcomes, but also reduces flexibility to consider exceptional cases outside the defined factors.

There are no rights of appeal created by the SoP itself; those rights exist under the VEA and MRCA generally. A claimant who is dissatisfied with a decision can seek internal review, then review by the Veterans’ Review Board, then the Administrative Appeals Tribunal, and ultimately judicial review. At each stage, the SoP will be applied.

The SoP also does not create any duties on private entities, such as employers or medical service providers. It is confined to the veteran compensation system. Its effects on private choice are minimal except to the extent that it may incentivise service personnel to document their exercise activities or to seek early medical advice for hip symptoms.

This SoP contains no penalty provisions. It is not a regulatory instrument that imposes fines or criminal sanctions. Its enforcement mechanism is indirect, operating through the compensation system. If the SoP is not applied correctly, a claimant may be wrongly denied compensation, or wrongly granted it. The enforcement of correct application occurs through the review and appeal mechanisms provided by the VEA and MRCA.

Specifically, a decision maker who misapplies the SoP may have their decision set aside on review. The claimant can seek review of a refusal if they believe the factors were met, or the Commonwealth can challenge a grant if they believe the factors were not met. In practice, the risk of enforcement falls on the decision maker to get it right. There are no individual penalties for officials who apply it incorrectly, but the Commonwealth may be liable for additional costs if incorrect decisions are made.

For claimants, there are no penalties for making a claim that fails to meet the factors, beyond the time and cost of preparing and pursuing the claim. However, if a claimant fraudulently claims false exercise history or false medical evidence, they may be subject to penalties under the Criminal Code or the VEA’s general fraud provisions, but that is beyond the SoP itself.

The instrument’s “enforcement” is therefore really about compliance with its terms by administrative decision makers. The SoP itself does not create a compliance burden for businesses or the general public. The only burden is the evidentiary burden on claimants to prove the factors. The instrument’s design encourages claimants to gather and present specific types of evidence, which may involve costs such as obtaining medical reports that satisfy the clinical onset definition, or obtaining records of exercise history from service and post service periods. For younger veterans or those who served many years ago, reconstructing exercise logs may be difficult.

The SoP is made under the VEA and sits within a broader legislative framework. Its direct interaction is with sections 120B of the VEA and 339 of the MRCA, which require that, for claims to which those sections apply, the decision maker must be satisfied, on the balance of probabilities, that the condition is related to service, and that the SoP provides the standard for that satisfaction. The SoP does not displace the general burden of proof in sections 120 and 120A of the VEA for operational service, but it operates for the types of service defined as “relevant service” in this instrument.

The instrument explicitly provides for interaction with other SoPs through section 11. If a factor refers to an injury or disease covered by another SoP, then the factors of that other SoP apply in accordance with its terms as in force from time to time. For example, factor 9(3) refers to inability to obtain appropriate clinical management. If that inability leads to another condition, or if the FAIS is associated with a labral tear, the decision maker may need to look at the SoP for labral tear if it is separately covered. This creates a cascading effect: the primary SoP imports other SoPs when factors point to them.

The SoP also interacts with the general medical evidence provisions of the VEA and MRCA. Even if no factor is met, the decision maker is not absolutely precluded from finding a connection if the medical evidence strongly supports it, but the SoP is designed to be the authoritative expression of the RMA’s view on the sound medical scientific evidence. In practice, if the factors are not met, it will be very difficult to succeed, because the SoP is taken to exhaust the accepted causal pathways.

The instrument repeals the previous 2017 SoP, meaning that any claims finally determined before the commencement of this new SoP are unaffected, but claims yet to be determined as at 19 January 2026 will be subject to this new instrument. Transitional provisions are not included in the instrument; the VEA and MRCA govern transitional issues.

The SoP also interacts with the Veterans’ Entitlements (Other Acts Instruments) and general administrative law. It is a legislative instrument registered on the Federal Register of Legislation, subject to disallowance (though rarely disallowed). It does not interact with state workers compensation or motor accident schemes, which are outside its scope.

This instrument, Statement of Principles concerning femoroacetabular impingement syndrome (Balance of Probabilities) (No. 4 of 2026), is a new standalone SoP that repeals and replaces the earlier SoP concerning the same condition, namely the Statement of Principles concerning femoroacetabular impingement syndrome (Balance of Probabilities) (No. 43 of 2017). The earlier instrument had the Federal Register of Legislation number F2017L00884. The repeal is effected by section 4 of the new instrument.

The new instrument also updates the date of effect: it commences on 19 January 2026. The previous instrument presumably remained in force until that date. The instrument explicitly states that it is made under subsection 196B(3) of the VEA, which is the balance of probabilities standard, as opposed to subsection 196B(2) which is for the reasonable hypothesis standard. The RMA typically issues dual SoPs for many conditions: one for balance of probabilities and one for reasonable hypothesis. This instrument is only the balance of probabilities version; there would be a companion SoP for reasonable hypothesis (likely No. 3 of 2026) covering operational service and hazardous service.

The instrument does not provide a detailed explanation of why the 2017 version was replaced or what changes were made. The only textual differences observable from the source are the definitions of clinical onset, cam morphology, pincer morphology, and the factors themselves appear similar to typical SoP structure. The note on the definition of clinical onset is new or at least present; the previous 2017 version may have had a different definition. The instrument includes notes about MET examples and that imaging date is usually after clinical onset, which may be clarifications.

The RMA’s process involves reviewing new medical evidence and then revoking and remaking SoPs. The amendment history is thus part of a cycle of updating based on medical research. No other amendments are made to this instrument after its making; it is a fresh instrument.

The instrument does not cite any litigation in its text, nor does it incorporate or refer to any court decisions. As a legislative instrument of the RMA, it is not itself a piece of litigation. However, SoPs in general have been the subject of judicial review proceedings, particularly in the Administrative Appeals Tribunal and the Federal Court. Claimants have challenged the validity of SoPs on grounds such as that the RMA did not consider sound medical scientific evidence, or that the factors are arbitrary or not based on evidence. The instrument’s recital that it was made on the basis of sound medical scientific evidence is a statement by the RMA, but it is susceptible to challenge.

The predecessor SoP (No. 43 of 2017) may have been litigated, but we cannot discuss that without specific information. The new SoP will likely be tested in future claims. There is no case law recorded in the instrument itself. We can note that the instrument is part of a well established framework and that the courts have generally deferred to the RMA’s expertise, though they have occasionally set aside SoPs if the RMA failed to follow procedures or made an error of law.

Because we must ground claims in the source, we can only say that no litigation history appears within the instrument. The absence of any mention of cases in the text means we cannot assert any specific case. We can note that the instrument is subject to judicial review and that litigation over similar SoPs has occurred, but that is background knowledge, not from the source. Better to be conservative: state that the instrument does not refer to any litigation, and that any challenge would be by way of review of decisions applying it.

Several aspects of this SoP may trap unwary claimants and practitioners. The definition of “clinical onset” is particularly tricky. It is defined as the point backwards in time from the first date of imaging findings of abnormal morphology to the date on which symptoms were persistently present, as assessed by a registered medical practitioner. This means that the clinical onset date may be years before any imaging was done. However, the definition does not require that symptoms were continuous from that point, only that they were persistently present at the time. If a patient had intermittent hip pain for many years but only sought imaging after a severe episode, the clinical onset could be placed earlier, but the medical practitioner must assess when it became persistent. This backward looking exercise is inherently subjective and may be contested. It also creates issues for the exercise factor: the 5 year cumulative period of exercise must be before clinical onset. If the clinical onset date is uncertain or set too early, the claimant may fail to meet the 5 year requirement even if they exercised heavily later.

The exercise factor itself is another trap. The requirement is “weight bearing exercise involving repeated activity of the hip on the affected side” at a minimum intensity of 8 METS. The note lists examples, but many service activities may not reach 8 METS. Running at moderate pace is about 8 METS, but many forms of military training, such as load carriage at slower speeds, may be lower. The claimant must have performed such exercise for at least 6 hours per week for a cumulative period of at least 5 years. That is a high threshold. Part time sport or occasional gym sessions are unlikely to satisfy. The claimant also needs to prove the activity was on the affected side, and that it was repeated (eg, not just occasional heavy lifting). For those with bilateral symptoms, it may be easier.

The clinical worsening factor (9(2)) requires the same exercise but only 1 year before clinical worsening. That might be easier to meet, but it only applies where the FAIS was suffered or contracted before or during (but did not arise out of) relevant service. So if the condition arose out of service, the worsening factor does not apply; only the onset factor applies. The instrument is clear: clinical worsening factors apply only to material contribution to or aggravation of already existing FAIS.

Factor 9(3) - inability to obtain appropriate clinical management - is open ended. “Inability” might include circumstances where the service environment prevented access to timely diagnosis, proper rest, or surgical consultation. However, the factor requires that this inability occurred before clinical worsening. It does not require a minimum period. This could be used where a person had symptoms but was not allowed to see a specialist due to posting or operational reasons. But it must be related to service.

Another trap: the instrument only applies to “relevant service” as defined - essentially non operational, non hazardous service. For operational service, the reasonable hypothesis SoP applies, which has a lower threshold. Claimants must be careful to identify which SoP governs their claim.

The dictionary definition of “clinical onset” also includes the condition that the point must be “as assessed by a registered medical practitioner”. This means the medical assessor must give a specific date. If a medical report says “unknown” or fails to give a date, the SoP cannot be applied, likely leading to a denial.

Finally, the note after subsection 7(2) states that it will “usually be the case that the date of the imaging findings of abnormal morphology at the hip joint is after the date of clinical onset.” That is a recognition that symptoms often precede imaging. But it may also create a presumption that the clinical onset is earlier. Claimants should ensure their medical evidence clearly states the date of persistent symptoms, not just the imaging date.

Compliance with this SoP is not about avoiding penalties; it is about successfully navigating the compensation claim process for FAIS. For claimants, the primary step is to obtain a diagnosis that meets the definition in section 7. That means a medical report from a registered medical practitioner (typically an orthopaedic surgeon or sports physician) that confirms (a) relevant symptoms and clinical signs, and (b) imaging findings of abnormal morphology (cam or pincer). The report should explicitly state that the diagnosis is femoroacetabular impingement syndrome.

Next, the claimant must establish the date of clinical onset. The medical practitioner should provide an opinion on when symptoms were persistently present, looking back from the first imaging date. It is wise to have contemporaneous medical records, if available, to support that opinion. Without a clear onset date, the exercise factor cannot be applied.

Then, the claimant must identify which factor (or factors) they can satisfy. The exercise factor requires proof of weight bearing exercise involving repeated hip activity at 8 METS or more, for at least 6 hours per week. The claimant should assemble service records, training logs, unit diaries, or personal records (e.g., fitness apps, running logs) that cover a cumulative period of at least 5 years before clinical onset. If the exercise occurred post service but still before clinical onset, that counts, but it must be related to service? No - factor itself must be related to service, but the factor is the exercise. The exercise must be related to the person’s relevant service. That means the exercise must have been undertaken as part of service or due to service, or while serving? The instrument says in section 10: “The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.” This is ambiguous: it could mean the factor itself must have occurred in the context of service, or that the factor’s existence must be causally connected to service. Typically, the RMA interprets this as requiring that the factor arose from service activities or occurred during service. For example, playing soccer as a service sport counts; playing soccer on weekends as a private activity may not, unless it was required by service. The claimant should try to link the exercise to service - e.g., unit physical training, inter unit sports, or physical instructors.

For the inability to obtain appropriate clinical management factor, the claimant must show that service prevented them from accessing appropriate care before the condition worsened. This could include evidence that they reported symptoms to a medical officer but were not given time off for surgery or physiotherapy, or that they were posted to a location with no specialist access. Documentation of requests for referral, denial of leave for treatment, or operational constraints is important.

The claimant should present their evidence in a structured way, referencing each element of the SoP. Legal practitioners assisting should ensure that any medical report addresses the definition of clinical onset, the MET levels if possible, and the temporal relationship to service.

For decision makers, compliance means carefully parsing the dictionary definitions. In particular, the definition of clinical onset must be applied as stated - it is the date when symptoms were persistently present, not the first symptom ever. The 5 year cumulative period for onset and 1 year for worsening are strict; they do not require continuous exercise every week, but the cumulative hours must reach 6 per week on average over the period? The wording “for at least 6 hours per week; and for cumulative period of at least 5 years” suggests the person must have done at least 6 hours per week for each week? Or it means over the cumulative period, the average was at least 6 hours per week? The better reading is that they must have exercised at that level consistently, but the instrument does not define “cumulative period” precisely. This is a potential interpretive difficulty.

Decision makers must also verify that the factor is related to service under section 10. That requires a causal or circumstantial link. The factor must have arisen from the person’s service, not just occurred while serving. For example, a person who was in the military but developed FAIS from civilian marathon running may not satisfy the relation requirement.

The SoP also imports other SoPs via section 11. If a factor involves another condition (like labral tear), the decision maker must apply the relevant SoP for that condition. That may introduce additional factors.